Enalapril- Part 2

-Concomittant treatment with NSAIDs increased the risk of renal damage -Angiotension II causes constriction of efferent arteriole (where blood flow comes out of the kidneys)-causes increased intraglomerular pressure → inc filtration + inc permeability (more proteinuria) -Giving ACEi/ARB→ reduced angiotensin II→ efferent arteriole is dilated→ reduced intraglomerular pressure + proteinuria, and eGFR falls slightly – this reduction in pressure is reno-protective (in diabetes and CKD) -BUT if there is reduced blood flow coming in afferent arteriole (blood coming into kidneys) and using ACEi allows the efferent arteriole to be dilated→ intraglomerular pressure drops significantly→ eGFR drops significantly- become nephrotoxic -Blood flow in afferent arteriole may be reduced by: drugs/vasoconstrictors (e.g. NSAIDs), dehydration, diarrhoea, vomiting, renal artery stenosis, sepsis. -Hyperkalaemia -Inc risk of hyperkalaemia – avoid giving it with potassium sparing diuretics (e.g. spironolactone), K supplements and any other drugs that increase K levels (e.g. trimethoprim) -If potassium levels are above 6.5- becomes medical emergency- could cause acute cardiac event -Monitoring Renal function + electrolytes should be checked before starting, any dose changes (within 7-10 days) and during treatment may need to inc monitoring if there are any issues -Contra-indicated in pregnancy- effect babies BP & renal func (skull defects & oligohydramnois (too little amniotic fluid)