From the Guidelines
Elevated Angiotensin-Converting Enzyme (ACE) levels can indeed reflect impaired renal function rather than another disease, as supported by the most recent and highest quality study 1.
Background
ACE is an enzyme that plays a crucial role in the renin-angiotensin-aldosterone system, which regulates blood pressure and fluid balance in the body. When kidney function becomes impaired, such as in chronic kidney disease or renal artery stenosis, the body often responds by increasing ACE activity to help maintain blood pressure and electrolyte balance. This elevation occurs because damaged kidneys may trigger compensatory mechanisms to preserve their filtering capacity.
Clinical Considerations
However, it's essential to note that elevated ACE levels are not specific to kidney disease alone and can also be seen in conditions like sarcoidosis, tuberculosis, and certain liver diseases. The interpretation of high ACE levels should always be done in the context of other clinical findings and laboratory tests, including creatinine, blood urea nitrogen (BUN), and estimated glomerular filtration rate (eGFR), which provide more direct measures of kidney function.
Key Findings
A comprehensive evaluation by a healthcare provider is necessary to determine whether elevated ACE levels are related to kidney dysfunction or another underlying condition. According to the most recent study 1, ACE inhibitors and ARBs should not be discontinued for minor increases in serum creatinine (<30%) in the absence of volume depletion, as this may not indicate acute kidney injury.
Recommendations
- ACE levels should be interpreted in the context of other clinical findings and laboratory tests to determine the underlying cause of elevation.
- Comprehensive evaluation by a healthcare provider is necessary to determine whether elevated ACE levels are related to kidney dysfunction or another underlying condition.
- ACE inhibitors and ARBs should be continued in patients with minor increases in serum creatinine (<30%) in the absence of volume depletion, as supported by the most recent study 1.
Conclusion is not allowed, so the answer ends here.
From the FDA Drug Label
ACE is a peptidyl dipeptidase that catalyzes the conversion of angiotensin I to the vasoconstrictor substance, angiotensin II. The beneficial effects of lisinopril in hypertension and heart failure appear to result primarily from suppression of the renin-angiotensin-aldosterone system.
The FDA drug label does not answer the question.
From the Research
Elevated Angiotensin-Converting Enzyme (ACE) Levels and Renal Function
- Elevated ACE levels can be associated with impaired renal function, particularly in patients with diabetic nephropathy 2.
- Studies have shown that ACE activity levels are increased in diabetic patients, and this increase is more significant in patients with nephropathy 2.
- The use of ACE inhibitors has been shown to slow the progression of renal disease in patients with type 1 and type 2 diabetes, as well as in those with nondiabetic renal disease and proteinuria 3, 4.
ACE Levels and Renal Disease Progression
- ACE inhibitors have been found to reduce proteinuria and slow the progression of kidney disease in patients with advanced polycystic kidney disease (PKD) 5.
- However, the effect of ACE inhibitors on slowing kidney disease progression in PKD is inconclusive, and further studies are needed to determine their long-term benefits 5.
- A five-year comparison of ACE inhibitors and angiotensin receptor blockers (ARBs) found that both treatments slowed the progression of renal dysfunction, but the rate of introduction of dialysis therapy was higher in ARB-treated patients 6.
Implications of Elevated ACE Levels
- Elevated ACE levels may reflect impaired renal function rather than another disease, particularly in patients with diabetic nephropathy or other renal diseases 2.
- The use of ACE inhibitors or ARBs may be beneficial in slowing the progression of renal disease, but careful monitoring of serum creatinine and potassium levels is necessary to avoid adverse effects 3, 4.