ACE+inhibitor+and+NSAID+function+recall

= ACE inhibitor and NSAID function recall =

//**Non-steroidal anti-inflammatory drugs (NSAIDs)**// All the NSAIDs inhibit prostaglandin synthesis, leading to unopposed, intrarenal vasoconstriction (i.e. PG normally keep the __afferent__ arterioles vasodilated to maintain GFR). This decreases the glomerular filtration rate. This results in fluid retention, with the risk of increasing cardiac failure in patients with pre-existing cardiac dysfunction, and resistance to antihypertensive therapy in patients with normal cardiac function.

By interfering with the production of angiotensin II, the ACE inhibitors decrease __efferent__ arteriolar regulation (ATII normally constricts efferent arteriole). Clinically significant alterations in renal function may result, particularly in low perfusion states, such as renal artery stenosis to a solitary kidney, or if there is bilateral renal artery disease. If the ACE inhibitor adversely affects renal function you should consider the presence of functionally significant renovascular disease, however the absence of such an effect does not rule out the presence of a renal artery lesion. Furthermore, a small deterioration in renal function may occur in patients who have no renovascular disease, but have a pre-existing mild elevation of serum creatinine when they start an ACE inhibitor. This deterioration will often reverse in time if the ACE inhibitor is continued.
 * //Angiotensin converting enzyme (ACE) inhibitors//**

Resources
http://www.australianprescriber.com/magazine/23/1/17/9/