Intensive Care Med (2018) 44:1159–1161 https://doi.org/10.1007/s00134-018-5223-8 EDITORIAL Angiotensin inhibition in patients with acute kidney injury: Dr. Jekyll or Mr. Hyde? 1* 2 Michael Joannidis and Eric Hoste © 2018 Springer-Verlag GmbH Germany, part of Springer Nature and ESICM Angiotensin-converting enzyme inhibitors (ACEIs) and These effects of ACEIs/ARBs, however, may become angiotensin receptor blockers (ARBs) are among the most highly unwanted in the situation of acute kidney injury frequently applied antihypertensive drugs. Their beneficial (AKI) where GFR has dropped because of a renal insult pleiotropic effects go far beyond blood pressure reduction. and a further reduction of GFR is clearly something treat- Remodeling of myocardium enhances the effects of after - ing physicians may want to avoid. This is even more rel - load reduction for the heart and makes ACEIs/ARBs a key evant in a situation where a patient is hemodynamically drug in treatment of chronic heart failure as well as for sec- unstable and ANG II inhibition hampers postglomeru- ondary prevention after acute myocardial infarction. With lar vasoconstriction which is key to preserving impaired regard to the kidney, ACEIs/ARBs have demonstrated to GFR. This effect is even more pronounced in patients reduce proteinuria and slow progression of CKD
Intensive Care Medicine – Springer Journals
Published: Jun 2, 2018
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