Altace - How does it help?

[Injecto]

What does Altace do in the kidneys to actually protect them from damage, or prolong their health?

I do take my 2.5mg per day pill, but I'm just taking it because I've been told to, now going on 2.5 years. But if kidney damage is the result of the filtration system getting bigger, thus letting bigger particles through, how does Altace help? Does it make the filter holes smaller? How?

[GretchO]

it's an ACE inhibitor (angiotensin converting enzyme). basically, it helps prevent the narrowing of blood vessels which leads to high blood pressure. it does this for the heart as well as kidneys.

"ACE is important because it is an enzyme responsible for producing the chemical, angiotensin II. Angiotensin II causes muscles in most arteries, including the arteries of the heart, to contract, thereby narrowing the arteries and elevating blood pressure. ACE inhibitors such as ramipril lower blood pressure by reducing the production of angiotensin II, thereby relaxing arterial muscle and enlarging arteries. When the blood pressure is lower, the heart - including the failing heart - does not have to work as hard to pump blood. The arteries supplying the heart with blood also enlarge during treatment with ACE inhibitors. This increases the flow of blood and oxygen to the heart, further improving the ability of the heart to pump blood.

In the kidneys, the narrowing of the arteries by angiotensin II decreases blood flow. ACE inhibitors enlarge and reduce the blood pressure in the arteries going to the kidney. This reduces damage to the kidneys caused by high blood pressure."

[Injecto]

So it only protects the kidneys by reducing blood pressure? Then if you don't have a blood pressure issue, taking an Ace Inhibitor does nothing to actually help. I thought Altace was doing something, like helping keep the filters small, or coating them and making them hard so that nothing large can get through. Dissapointing.

[foxl]

So it only protects the kidneys by reducing blood pressure? Then if you don't have a blood pressure issue, taking an Ace Inhibitor does nothing to actually help. I thought Altace was doing something, like helping keep the filters small, or coating them and making them hard so that nothing large can get through. Dissapointing.

No -- apparently it has been found to help, even if you have normal blood pressure!

ace inhibitors in renal failure - Google Search (http://www.google.com/search?source=ig&hl=en&rlz=1G1GGLQ_ENUS328&q=ace+inhibitors+in+renal+failure&aq=0&oq=ace+inhibitors+in+ren&aqi=g5)

Scan some of those ... this is a good drug class.

[Injecto]

Funny enough, I found more articles that say an ACE inhibitor is only beneficial if it is taken for high blood pressure. Furthermore, I've read that taking an ACE inhibitor can actually cause renal failure.

From the second link on your google search I found this:

"If these patients take an ACE inhibitor, their glomerular filtration rate decreases, and prerenal acute renal failure can develop. " Not good news.

ACE-inhibitors for renal disease and diabetes? [July 2001; 89-2] (http://www.medicine.ox.ac.uk/bandolier/band89/b89-2.html)
this article seems to say that you should only take an ACE if you have chronic kidney failure.

Why does there seem to be a lack of explaining how ACE inhibitors help protect the kidneys if not related to blood pressure or already diagnosed chronic kidney failure? As it stands, I have perfect Blood Pressure and not kidney failure, and so I'm starting to think that my taking an ACE is either useless or infact dangerous.

[foxl]

Funny enough, I found more articles that say an ACE inhibitor is only beneficial if it is taken for high blood pressure. Furthermore, I've read that taking an ACE inhibitor can actually cause renal failure.

From the second link on your google search I found this:

"If these patients take an ACE inhibitor, their glomerular filtration rate decreases, and prerenal acute renal failure can develop. " Not good news.

ACE-inhibitors for renal disease and diabetes? [July 2001; 89-2] (http://www.medicine.ox.ac.uk/bandolier/band89/b89-2.html)
this article seems to say that you should only take an ACE if you have chronic kidney failure.

Why does there seem to be a lack of explaining how ACE inhibitors help protect the kidneys if not related to blood pressure or already diagnosed chronic kidney failure? As it stands, I have perfect Blood Pressure and not kidney failure, and so I'm starting to think that my taking an ACE is either useless or infact dangerous.


Wow -- then I need to go back and find the info I had read earlier, (like a few wks ago) then. Because I DID read ACE inhibitors are beneficial in diab etic CRF ... with normal BP. Honest ... I did, somewhere!

[DeusXM]

On a related note, is anyone aware of the beneficial differences between ACE inhibitors and angiotensin II receptor antagonisers? I'm fairly sure the method of action differs in that the inhibitors prevent the production of the enzyme while the antagonisers prevent the use of the enzyme, but are there any other major differences?

[foxl]

On a related note, is anyone aware of the beneficial differences between ACE inhibitors and angiotensin II receptor antagonisers? I'm fairly sure the method of action differs in that the inhibitors prevent the production of the enzyme while the antagonisers prevent the use of the enzyme, but are there any other major differences?


Side effects of ARBs are much lower, Deus. Not sure about actual action being otherwise beneficial.

[It Ain't Over]

On a related note, is anyone aware of the beneficial differences between ACE inhibitors and angiotensin II receptor antagonisers? I'm fairly sure the method of action differs in that the inhibitors prevent the production of the enzyme while the antagonisers prevent the use of the enzyme, but are there any other major differences?

Side effect (coughing) is less of a problem. My endo switched me to Diovan;an ARB, from an ACE because of the coughing. He said at the time the ACE has been around longer and was better studied. It has been shown to clearly reduce heart and kidney problems and is safe for diabetics. With regard to the ARB he said they are a later arrival and are not as well studied, but the reports he had seen were that the ARB may work better than the ACE.
He also said best that all patients treating for D use one or the other. When we have hi blood sugar that enzyme mentioned here is dumped in large amounts into the bloodstream and causes a lot of damage. Apparently this is thought to be the lead cause of renal failure with diabetes.

[LeslieH]

Hi everyone,

I have some understanding about these drugs that may help answer the mystery of their actions. As an FYI, I work as a paramedic educator and often teach pharmacology and physiology to emergency medical technicians. I've had type 1 diabetes for 20-ish years (diagnosed at the age of 18) and take an ARB (Benicar).

ACE Inhibitors and ARBs (angiotensin 2 receptor blockers) work in 2 ways to protect the kidneys: lowering blood pressure (BP) and in binding to protein (albumin) in the bloodstream.

The job of the kidneys is to filter the blood. Think of a wastewater treatment plant. All of the the blood goes into the plant and the machines of the plant separates out the waste. In the kidneys, the filtering machines are called nephrons. There are over 1 million of these in each kidney.

In diabetes, high levels of glucose will damage nephrons over time. These "machines" will have a hard time filtering the bad stuff out while keeping the good stuff in. Albumin, a protein of the blood, is one of the good elements that end up in the waste.

On a side note, one of the urine tests that the doctors will check in a diabetes patient will look for the levels of albumin. The presence of albumin in urine tells the doctor that the filtering machines are damaged. The more albumin that is found in the urine, the more damage to the filtering plant.

Albumin is the reason why we take ACE inhibitors and ARBs for kidney protection. Bare with me for a moment while I talk about albumin's work in kidney disease.

Albumin is a protein that is normally found in the bloodstream and acts as freight ship for other substances in the blood like free fatty acids.

The freight ship (albumin) will stop at the wastewater plant, drop some of its cargo and go back into the bloodstream. When the plant is damaged, it will suck in the ship and its cargo, then purge it out with all the other waste. This is a big problem. The ships hang around in the machines for a while and the cargo will begin to erode the machines. So, in the body, the albumin accumulates in the nephrons, the free fatty acids are pushed into the walls of the nephron and damages them. At least this is the theory.

OK, here comes the actual answer to your question!

ACE inhibitors and ARBs will bind to albumin like a tugboat will attach to a cargo ship. In this case, the drug (tugboat) will keep the ship from getting sucked into the wastewater plant. So, in diabetes, the drugs won't prevent the primary damage of the kidneys (this is from high glucose), but they will prevent the secondary damage that comes from the albumin. At least this is the thought process of researchers.

Be aware that this is a very simple explanation of a complicated process, so some details may have been left out. Also, some of these "facts" about drug binding and prevention are still presented as theory by the researchers. My sources for this information are below.

There's something also exciting that is coming out of the research for ARBs. Researchers are finding that ARBs are having a significant impact on the slowing of diabetic retinopathy. This is for reasons totally different from above.
If you don't mind medical-ese wording, then check out this website: Effect of angiotensin receptor blockade on endothelial function: focus (http://dovepress.com/effect-of-angiotensin-receptor-blockade-on-endothelial-function-focus--peer-reviewed-article).

Sources:
National Kidney and Urologic Diseases Information Clearinghouse (NKUDIC).

The proximal tubular cell, a key player in renal damage - NIER (http://www.nieronline.org/index.php?title=The_proximal_tubular_cell%2C_a_key _player_in_renal_damage) (from a Google search of "albumin kidney damage")

Kidney International -

Take care,
Leslie

[foxl]

Well I have not gotten further into the phyiology or biochemistry of ACE inhibitors and ARBs ... but if you wnat more info on clinical studies showing efficacy, the keyword is ONTARGET in Pubmed -- study name.

Also do take a peek at my recent thread on Ramipril (Altace) preserving beta cell mass ....

[Bull]

I have been taking Altace for HBP before they found my Diabetes.

[foxl]

Good for you Bull! It is good stuff.

I have been on it since Weds and no side effects -- hooray!