What blood pressure medicine damage kidneys?

• Lisinopril (Zestril)
• Benazepril (Lotensin)
• Enalapril (Vasotec)
• Ramipril (Altace)

If you have chronic kidney disease (CKD), diabetes, or high blood pressure—or if you take certain blood pressure medicines that affect your kidneys—you should take steps to protect your kidneys from harm.

ACE inhibitors and ARBs are two types of blood pressure medicine that may slow the loss of kidney function and delay kidney failure. You can tell if you’re taking one of these medicines by its generic name. ACE inhibitors end in –pril and ARBs have generic names that end in –sartan; for example, lisinopril and losartan.

You may also take a diuretic, sometimes called a water pill, to meet your blood pressure goals.

The information below explains

The next time you pick up a prescription or buy an OTC medicine or supplement, ask your pharmacist how the product may affect your kidneys or react with other medicines you take.

Fill your prescriptions at only one pharmacy or pharmacy chain so your pharmacist can monitor your medicines and supplements, and check for harmful interactions between your medicines.

Keep an up-to-date list of your medicines and supplements in your wallet. Take your list with you, or bring all your medicine bottles, to all health care visits.

If you take OTC or prescription medicines for headaches, pain, fever, or colds, you may be taking a nonsteroidal anti-inflammatory drug (NSAID). NSAIDs include popular pain relievers and cold medicines that can damage your kidneys if you take them for a long time, or lead to acute kidney injury if you take them when you are dehydrated or your blood pressure is low.

Ibuprofen and naproxen are NSAIDs. NSAIDs are sold under many different brand names, so ask your pharmacist or health care provider if the medicines you take are safe to use.

You also can look for NSAIDs on Drug Facts labels like the one below.

Almost everyone gets sick once in a while. Your doctor or pharmacist can help you plan ahead to keep your kidneys safe until you get well. Prepare in advance so you know what to do if you have pain or a fever, diarrhea, nausea, or vomiting, which can lead to dehydration.

Before you get sick, ask your health care provider or pharmacist the following questions

Discuss this video with your doctor, nurse, or pharmacist before you make any changes to the way you take your medicines.

In normal, everyday circumstances, taking your blood pressure medicines as prescribed helps protect your kidneys. However, certain situations, such as when you’re dehydrated from the flu or diarrhea, can lower the blood flow to your kidneys and cause harm.

When you get sick from something like the flu or diarrhea, or have trouble drinking enough fluids, the blood pressure in your body may decrease. As a result, the pressure in your kidneys can be low, too.

In most cases, healthy kidneys can protect themselves. However, if you keep taking your blood pressure medicines when you’re dehydrated or have low blood pressure, your kidneys might have a hard time protecting themselves. The pressure within your kidneys might drop so low that your kidneys won’t filter normally.

If you’re dehydrated, NSAIDs can also keep your kidneys from protecting themselves. As a result, taking NSAIDs when you’re sick and dehydrated can cause kidney injury.

Read about what else you can do to keep your kidneys healthy. If you already have CKD, the steps you take to protect your kidneys also may help prevent heart disease—and improve your health overall.

The National Institute of Diabetes and Digestive and Kidney Diseases (NIDDK) and other components of the National Institutes of Health (NIH) conduct and support research into many diseases and conditions.

Names of Common Blood Pressure Medicines

There are different types of blood pressure medicines that your doctor may prescribe to control your high blood pressure. You may even already be taking one or more of them.

Thiazides

Angiotensin-Converting Enzyme Inhibitors

Angiotensin II Receptor Blockers

Calcium Channel Blockers

Beta Blockers

Information Provided as Part of a UCSF Study:

Care For Your Kidneys

Study Investigator:

Veronica Yank, MD

[email protected]

Your kidneys are part of a well-designed filtering system for your body. They remove toxins, waste, and extra fluids from your blood through urine.

But if your kidneys get injured or damaged, it can prevent them from filtering out waste like they’re supposed to. Certain health conditions — like diabetes and high blood pressure — and several medications can cause this type of damage.

Medications that are harmful to the kidneys are called nephrotoxic medications. Some of these medications mildly worsen kidney function, while others could cause more serious injury. Your risk for kidney damage depends on your individual health conditions and the medication(s) you’re taking.

Highlighted below are 10 of the top medications that have been linked to kidney damage.

Nonsteroidal anti-inflammatory drugs (NSAIDs) are popular remedies for pain and fever. And they’re widely used to treat a host of health conditions, such as rheumatoid arthritis, menstrual pain, and inflammation.

Some common NSAIDs are:

While NSAIDs have many uses and are generally well-tolerated, taking them also poses some risks. These medications can affect blood flow through the kidneys, which can contribute to kidney damage or failure. People with heart failure, liver disease, or existing kidney problems are at a higher risk for experiencing new or worsening kidney problems related to NSAIDs.

In general, it’s best to take NSAIDs sparingly, at their lowest effective dose, and for the shortest period of time possible. Occasional doses of NSAIDs taken in recommended amounts are much less likely to cause kidney damage.

Diuretics, or water pills, treat health conditions such as high blood pressure and heart failure. Popular diuretics include:

These diuretics are typically well-tolerated but, as with all medications, they can cause side effects. Diuretics are associated with a risk of acute kidney injury, especially in older adults. This is likely because diuretics lower blood volume, which disrupts the filtration process.

Kidney damage is more likely with higher doses of diuretics.

Angiotensin-converting enzyme (ACE) inhibitors can be good and bad for your kidneys. These medications are easily identifiable because they end in “-pril,” such as:

ACE inhibitors are go-to medications for managing high blood pressure and heart failure. And in these conditions, they can also protect the kidneys. But ACE inhibitors are cleared out of the body through the kidneys, so they also carry a risk of causing kidney injury.

You’re more likely to experience kidney problems related to an ACE inhibitor if you’re dehydrated or taking other nephrotoxic medications. In either case, you will likely start on a lower dose. Your healthcare provider may also recommend that you come in for routine blood tests to monitor your kidney health over time.

Although it sounds like a complicated term, iodinated radiocontrast refers to contrast dyes used during radiographic testing, such as a CT scan. The dyes make your organs and blood vessels more visible during the scan.

The downside is that iodinated radiocontrast agents can lead to kidney injury. This type of kidney injury usually appears within 24 to 48 hours of receiving the contrast. And the risk factors include existing chronic kidney disease, diabetes, having low blood volume, and taking other nephrotoxic medications.

For people who are at risk of kidney injury from radiocontrast dyes, providers will often lower the amount that is used during a test.

Vancomycin is an antibiotic used to treat serious methicillin-resistant Staphylococcus aureus (MRSA) infections. It’s frequently used in hospital settings.

Kidney damage from vancomycin usually happens within 4 to 17 days after beginning treatment with the medication. And kidney function usually improves after treatment is stopped. Pharmacists and prescribers in the hospital work together to closely monitor you and your vancomycin dose every time it’s administered.

Aminoglycoside antibiotics, when given as an IV infusion, are known for causing kidney injury. People with chronic kidney disease, who are dehydrated, or who have been taking these antibiotics for longer than 10 days are at particularly high risk for this side effect.

Common IV aminoglycoside antibiotics include:

These medications are typically only used in hospital settings, which allows for close monitoring during treatment. A healthcare provider may adjust a person’s dose to be less harmful to their kidneys depending on their medical history and treatment response.

Certain HIV medications have been linked to kidney damage. Tenofovir disoproxil fumarate (Viread) — on its own and in combination products like Truvada and Stribild — can cause acute kidney injury in certain situations. The same goes for atazanavir (Reyataz).

It’s important that anyone planning to take one of these medications should first be screened for kidney problems. If a person has kidney problems, they may need to take a lower dose for safety purposes.

Not all HIV medications carry this risk. For instance, the newer formulation of tenofovir, tenofovir alafenamide (Vemlidy), is less likely to cause kidney toxicity. This is also true for tenofovir alafenamide combination products, like Descovy and Biktarvy.

Some other antiviral medications, like acyclovir (Zovirax) and ganciclovir, can also cause kidney injury. These medications can produce crystals that do not dissolve in urine. These crystals can cause blockages in your filtration system. This side effect is more likely to affect people who are dehydrated or have existing kidney disease.

Foscarnet is another nephrotoxic medication that treats viral infections. It’s not a commonly prescribed medication, but it can cause kidney damage rather easily. So, if you need it, your healthcare provider will closely track your kidney function.

Zoledronic acid (Reclast) belongs to a group of medications called bisphosphonates, which are used to treat osteoporosis. Kidney damage is a rare but serious side effect associated with zoledronic acid. And the FDA issued a formal warning regarding the risk.

In general, Reclast generally shouldn’t be given to people with abnormal kidney function or preexisting kidney damage. This is also true for Zometa, another version of zoledronic acid used to treat high calcium levels that can occur with certain types of cancer.

Calcineurin inhibitors, like cyclosporine modified (Neoral) and tacrolimus (Prograf), are  immunosuppressants commonly prescribed to people who have had an organ transplant. These medications have the potential to cause kidney damage.

The benefits of these life-saving medications often outweigh the potential risk of kidney damage, but it’s still good to keep in mind. The risk of kidney damage related to cyclosporine or tacrolimus is worse with higher doses and in people who are already at risk of kidney damage. If you take either of these medications, your healthcare provider will likely monitor your kidneys.

It’s not always easy to tell if you have kidney damage. You might not experience any symptoms at all. And your healthcare provider may only notice signs of it after running certain lab tests.

But if you do notice any of these symptoms, talk to your healthcare provider right away:

If you report any of these side effects, your healthcare provider will likely order lab tests to evaluate your kidney health. Based on these results and what medications you are taking, you may need to stop or pause treatment. In some cases, you may be able to switch to a medication that is safer for your kidneys.

However, investigators say patients should continue to take the potentially life-saving medications, which include well-known and widely used angiotensin-converting enzyme (ACE) inhibitors) while research to better understand the long-term effects of the drugs continues.1

“Our studies show that renin-producing cells are responsible for the damage. We are now focusing on understanding how these cells, which are so important to defend us from drops in blood pressure and maintain our well-being, undergo such transformation, and induce kidney damage,” Maria Luisa Sequeira-Lopez, MD, of UVA’s department of pediatrics and child health research center, said in a statement.1

“What is needed is to identify what substances these cells make that lead to uncontrolled vessel growth,” she said.1

Investigators found that specialized kidney cells called renin cells play an important role in organ damage. The cells normally produce renin, which is a vital hormone that helps the body regulate BP, but harmful changes in the renin cells can cause the cells to invade the walls of the kidney’s blood vessels.1

The renin cells can trigger a buildup of another cell type, called smooth muscle cells, which cause the vessels to stiffen and thicken, making it harder for blood to flow through the kidney as it should.1

The investigators also found that the long-term use of drugs that inhibit the renin-angiotensin system, such as ACE inhibitors, have a similar affect.1

The long-term use of these drugs was associated with hardened kidney vessels in both humans and lab mice.1

“It would be important to conduct prospective, randomized controlled studies to determine the extent of functional and tissue damage in patients taking medications for blood pressure control,” Ariel Gomez, MD, of UVA’s department of pediatrics and child health research center, said in the statement.1 “It is imperative to find out what molecules these cells make so that we can counteract them to prevent the damage while the hypertension is treated with the current drugs available today.”1

Hypertension puts individuals at risk for heart disease and stroke, which are the leading causes of death in the United States.2

Nearly half (47%) of adults in the United States, or about 116 million, have hypertension, and hypertension was a contributing or primary cause of more than half a million deaths in 2019, according to the CDC.2

Uncontrolled hypertension is defined as diastolic BP greater than 80 mmHg or systolic BP greater than 130 mmHg.2