A 65-year-old hypertensive patient with a history of chronic kidney disease (CKD) is prescribed enalapril. After a few days, he presents with elevated serum creatinine and hyperkalemia.
Explain the pharmacological basis of enalapril’s adverse effects in this patient. What alternative antihypertensive agents would be safer in the context of CKD and why?
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So enalapril is an ACE inhibitori.e it reduces BP by blocking the conversion of angiotensin I to angiotensin II. That lowers vasoconstriction and aldosterone release.
In healthy people, that’s helpful. But in CKD patients, especially elderly hypertensives, angiotensin II actually plays a protective role by maintaining the tone of the efferent arteriole in the glomerulus. It keeps the glomerular filtration pressure up.
When you block that with enalapril, the efferent arteriole dilates → glomerular pressure drops → GFR drops → serum creatinine rises. That’s why the kidney function worsens in some CKD patients.
Also, ACE inhibitors reduce aldosterone, which normally helps excrete potassium. So less aldosterone → more potassium retention → hyperkalemia.
What’s safer instead?
In CKD:
- Calcium channel blockers (like amlodipine) are generally safe. They lower BP without messing with renal autoregulation or potassium levels.
- Beta-blockers (especially in cases with concurrent heart disease)
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Enalapril reduces angiotensin II, lowering glomerular pressure and causing decreased GFR and hyperkalemia.
In CDK this worsens kidney functions. Some safer alternatives would be amlodipine or beta blockers.
Enalapril, messes with the kidney function by decreasing Angiotensin 2.
Enalapril can harm kidneys and raise potassium in CKD by impacting blood flow.
Safer choices are often Calcium Channel Blockers or specific diuretics, as they avoid these risks for compromised kidneys.
What is the MOA behide enalapril raising potassium levels?