Renal effects of converting enzyme inhibition

Angiotensin-converting enzyme inhibition, by preventing the generation of angiotensin II, has some pronounced effects on renal function. Its actions occur at the vascular, the glomerular, the juxtaglomerular, and also at the tubular medullary level. In clinical medicine, depending on the circumstances of the patients under treatment, converting enzyme inhibitors can interfere with renal hemodynamics and glomerular filtration, with solute excretion by the kidney and other variables of normal renal function. In most circumstances, the effects of converting enzyme inhibition on the kidney are rather beneficial to the patient. However, under some extreme conditions, they may become potentially hazardous. A basic understanding of the physiology of the renin-angiotensin system and of its actions on the kidney makes it possible to understand the impact of the converting enzyme inhibitors, to avoid most of the unwanted effects and to ensure greatest benefit to the patient.