Excellent presentation! I’d like to see this same level of explanation for TBMD, also causing high BP and how protective or detrimental an ACEI would be in that scenario.
Thank you! I actually hadn't heard of TBMD until you mentioned it. That's an interesting genetic disorder. I would expect the ACEIs to be more protective in the case of TBMD, and possibly same or less risk in cases of low renal blood flow, since glomerular filtration should theoretically be greater than normal. I haven't read up on the disorder thoroughly though, so I could be wrong.
Thank you Dr. Adam for the reminder. After I've been away from this stuff for years, it's annoying how much knowledge I lost. Truly though, because I used to know this stuff like I knew my name. It's unfortunate.
@@AVW_Dr.Dr. Oops should've specified. No I was a medical student. But I lagged on my life, stagnated, and didn't continue forward. All my colleagues and everyone has went forward and I am still supposed to be studying for STEP1.... Which I also failed twice because of zero preparation. I'm screwed.
The American Heart Association lists a systolic pressure of 130-139 mmHg, or a diastolic pressure of 80-90 mmHg, as Stage 1 hypertension. There is no specific blood pressure cutoff where kidney damage all of the sudden occurs. It is more of a gradient, where higher is worse. I would personally not be comfortable at or higher than 140/90 with respect to my risk for kidney damage. If either number is at that level I would be concerned. The damage doesn't happen immediately, but over years. However, if you are at 180/120 it could happen much faster.
So my situation is different and would greatly appreciate your input. My kidneys are fine. Perfect. I had my gall bladder removed (the old fashion way due to infection). I had blood loss during surgery, but not enough to require a transfusion. After surgery, my kidney values were horrible. They came back while in the hospital somewhat…..that was in 2007. I have high blood pressure but has been controlled very well for years. 2006 BUN 15 ….to 45 after surgery, now upper 20’s…….Creat. 2006 = 1 , after surgery 2.4….now around 1.3 to 1.5…… 46 yr old at time of surgery, now 63. When on Lisinopril, it increases test result creatinine and bun numbers…..when off, numbers drop down again. My question…is Lisinopril protecting my kidneys or hurting them, based only on the data above? Thank you!
Hi. Is that range you listed now while you are taking lisinopril or does lisinopril make creatinine go above 1.5? 1.3 is the upper limit of the normal range, but if it goes to 1.5 only while on lisinopril I personally wouldn't be too concerned. Once you start getting into your late 60s and older it is normal to have gradually declining kidney function, but it's very gradually usually. I don't see any evidence that lisinopril is harming your kidneys, and it wouldn't be true renal damage from the lisinopril, , but just low glomerular pressure. Now if you had a more severe rise in creatinine after starting lisinopril I'd be concerned you had renal artery stenosis. However, from what you've said I don't see evidence of that. Keep in mind there are many other factors that your physician would be aware of, and you should be having this conversation with him/her. I am not a physician, but I do teach renal physiology and pharmacology. So, I hope I have helped clear some things up.
Hi. I'm no expert on IgA nephropathy, but upon a brief search, it looks like it damages your glomeruli (filters) in the kidneys. According to Penn Medicine, ACE inhibitors may be used to help in cases of high blood pressure (hypertension) or fluid retention (edema). Unfortunately, ACE inhibitors will not directly resolve the underlying issue, which is too much IgA (an antibody) deposited in your glomeruli. IgA is a protein, and protein can get stuck in leaky capillaries, such as those in glomeruli. It is really an interesting but unfortunate disease. www.pennmedicine.org/for-patients-and-visitors/patient-information/conditions-treated-a-to-z/bergers-disease-iga-nephropathy#:~:text=IgA%20nephropathy%20is%20a%20kidney,is%20also%20called%20Berger%20disease. It looks like the only treatments currently recommended do not directly solve the underlying problem, other than perhaps corticosteroids, which can lower IgA level, but those have many side effects, which get worse when used chronically. Someone needs to fund gene therapy to lower IgA levels, without completely abolishing them. Also, to avoid affecting the other parts of the immune system.
Hello. Let me clarify. ARBs protect the kidneys in most cases of hypertension. It is only when someone has bilateral renal artery stenosis that RAAS inhibitors (such as ARBs) are a risk. So, you shouldn't have a cause for concern unless you have renal artery stenosis, and that it something your physician should be communicating with you. Please let me know if you have further questions.
Thanks so much for the video - A few questions. I have high BP and taking an ARB (Telmisartan). The ARB is reducing blood pressure somewhat, but it's still elevated - often in the high 130's or low 140's. It doesn't seem there are other options to pair to the ARB because I have Bradycardia, so Beta Blockers are out ... and I am very active with exercise, so both Calcium Channel Blockers and Diuretics would cause pretty bad side effects. egfr, BUN and Creatinine are all good. CT Cardiac score is zero. I'm honestly more concerned about long term kidney damage than heart damage - since studies seem to show that if you are active, high blood pressure isn't nearly as dangerous for the heart as if you are inactive ... In the case that BP is still elevated, is the ARB still protective of the kidneys? I have been trying to have this conversation with my cardiologist, but I think I'm a bit over her head with these sorts of questions, and I need to find another cardiologist who works with athletes. Thanks!
You're welcome! I am a bit surprised that a cardiologist would have any issues answering your questions, but I wouldn't be surprised if it were because of little time, and too many patients. What exactly is your concern with calcium channel blockers? Dihydropyridine calcium channel blockers do not suppress the heart, so they are not detrimental to exercise. That would be anything ending in "pine", such as nifedipine.
@@AVW_Dr.Dr. my concern is that the calcium channel is also part of what sends contractile signals to all muscles, not just the heart. Is that not accurate?
@@philrosenthal6999 I understand your concern, but this article appears to confirm that although L-type calcium channels exist in skeletal muscle, they do not appear to be important in contraction. Calcium from intracellular stores was shown to be sufficient for normal muscle function. www.nature.com/articles/s41467-017-00629-x Also, I'm not aware of calcium channel blockers causing issues with exercise, as long as they are the dihydropyridine type.
Hi, and good day! Always confirm everything with your physician, but ACE inhibitors, such as enalapril, are protective to the kidney unless you have bilateral renal artery stenosis. Then they are contraindicated. Or, also contraindicated if you had one kidney and renal artery stenosis.
Hi! Always confirm everything with your physician, but ACE inhibitors are protective to the kidney unless you have bilateral renal artery stenosis. Then they are contraindicated. Or, also contraindicated if you had one kidney and renal artery stenosis. Renal artery stenosis is usually diagnosed when you have a sharp rise in serum creatinine (generally more than 30%) after starting the ACE inhibitor.
Hi I forgot to mention last month I was diagnosed ischemia heart disease will that have an affect on my kidneys also am type 2 diabetes and unstable blood pressure it.s either to high and to low am from the UK
Okay, it looks like there is a lot more going on than I feel is safe to answer on here. All these questions are important to bring up to your physician. The best thing you can do to protect your kidneys with Type 2 diabetes is keep your blood sugar within the normal range. Not too high, not too low. Ischemic heart disease can affect several other organs depending on the severity and other factors. I strongly encourage you to keep up with your visits and checkups, as there are so many other factors, including your lab values.
