How does lisinopril affect your kidneys?

In this article:

• Does lisinopril cause kidney damage?
• How does lisinopril support renal function?
• Optimal dosage for kidney protection
• Alternatives to lisinopril
• The bottom line

In this article

• Does lisinopril cause kidney damage?
• How does lisinopril support renal function?
• Optimal dosage for kidney protection
• Alternatives to lisinopril
• The bottom line

Lisinopril is a prescription medication commonly used to treat hypertension (high blood pressure) and heart failure. It can also improve survival after a heart attack or myocardial infarction. It is part of a class of drugs known as angiotensin-converting enzyme (ACE) inhibitors. It works by relaxing the blood vessels, enhancing blood flow, and allowing the heart to pump blood more effectively.

Although lisinopril is not specifically FDA-approved for treating kidney problems, it is commonly used to help protect the kidneys, especially in individuals with high blood pressure or diabetes mellitus, which can affect kidney function. It slows down kidney damage by lowering blood pressure, reducing stress on the kidneys, and blocking hormones that can worsen kidney function. 

Does lisinopril cause kidney damage?

Lisinopril, like other ACE inhibitors, can have complex effects on kidney function. While lisinopril is often used to protect the kidneys, especially in individuals with high blood pressure or diabetes, there are instances where it may cause kidney damage. The risk is higher in people with kidney disease or other risk factors.

Potential kidney damage from lisinopril is often reversible. If a patient experiences kidney problems, discontinuing the medication or lowering the dosage (under the guidance of a healthcare provider) can often lead to improvement. Monitoring kidney function regularly when starting or adjusting lisinopril is important to detect potential issues early.

In addition to its effects on kidney function, lisinopril can increase potassium levels in the blood, causing hyperkalemia. People with certain conditions, such as heart failure, dehydration, or preexisting kidney problems, are already at higher risk for hyperkalemia because their kidneys may not effectively regulate potassium levels. This risk is further heightened if they take potassium-sparing diuretics or potassium supplements. Therefore, regular monitoring of potassium levels is required while taking lisinopril.

Glomerular filtration rate (GFR) is a test to see how well the kidneys are working. It estimates how much blood passes through the glomeruli (tiny filters in the kidneys that remove waste from blood) every minute. A lower-than-normal GFR can indicate kidney problems or damage. ACE inhibitors like lisinopril work in part by slowing damage to the glomeruli, which can help those with kidney disease.

How does lisinopril support renal function?

ACE inhibitors like lisinopril play a crucial role in supporting kidney function. They work by lowering the pressure in the tiny blood vessels of the kidneys and easing blood flow through them. This helps reduce stress on the kidneys and protects them from damage. This action helps prevent the progression from microalbuminuria (small amounts of protein in the urine) to more severe proteinuria (larger amounts of protein in the urine).

ACE inhibitors offer long-term protection against the development and progression of proteinuria and can stabilize kidney function, especially in individuals with impaired renal function.

For patients with chronic kidney disease (CKD), ACE inhibitors or angiotensin receptor blockers (ARBs) are often the first-choice medications. They are more effective than placebo (inactive medicine) in reducing proteinuria and slowing the progression of kidney disease. The effectiveness of ACE inhibitors and ARBs in this regard is generally comparable.

In cases of glomerular diseases and post-transplant glomerulonephritis (a type of kidney inflammation that can occur after a kidney transplant), ACE inhibitors or ARBs are essential treatments. They help to slow the decline in glomerular filtration rate (GFR) and reduce proteinuria. Additionally, these drugs have been found to prolong graft survival in patients with post-transplant glomerulonephritis.

A common myth about ACE inhibitors and ARBs is that they are beneficial only for people with high blood pressure. This is not true. These medications can also benefit individuals with kidney disease or heart failure, even if they do not have high blood pressure. For those without high blood pressure, a lower dose may be recommended to avoid low blood pressure.

Optimal dosage for kidney protection

Lisinopril dosage varies based on several factors, including overall health, kidney function, and co-occurring medical conditions. Here are some general dosing guidelines for adults based on the prescribing information:

• High blood pressure: The starting dose is 10 mg by mouth once daily. For those also taking a diuretic (water pill), the starting dose may be 5 mg once daily. The healthcare provider may gradually increase the dose as needed, up to 40 mg by mouth once daily.
• Heart failure: The starting dose is 5 mg by mouth once daily. The healthcare provider may gradually increase the dose as needed, up to 40 mg by mouth once daily.
• Survival after myocardial infarction (MI): The initial dose is 5 mg within 24 hours of MI, followed by 5 mg after 24 hours, then increasing to 10 mg once daily.

For individuals with preexisting kidney problems, healthcare providers generally prescribe a lower starting dose, often 2.5 mg or 5 mg once daily, based on creatinine clearance levels. The dose may be adjusted according to kidney function and response to treatment. Regular monitoring of kidney function is crucial when starting lisinopril or adjusting the dose. If kidney function worsens, the healthcare provider may lower the dosage further or recommend alternative treatments.

Alternatives to lisinopril

Some of the most common side effects of lisinopril include:

• Dry cough
• Headache 
• Dizziness
• Tiredness
• Weakness 
• Stomach problems such as nausea and diarrhea
• Sexual problems

Some other potential side effects include elevated potassium levels (as mentioned above) and, in rare cases, an allergic reaction called angioedema (swelling under the skin).

While lisinopril is effective for many patients, some may consider alternative medications due to side effects or other factors. Alternatives such as these can offer similar benefits but may have different side effect profiles and benefits or risks to consider:

• Angiotensin receptor blockers (ARBs), such as Diovan (valsartan) or Cozaar (losartan)
• Beta blockers, such as Tenormin (atenolol) or Toprol XL (metoprolol)
• Diuretics, such as hydrochlorothiazide (often used in combination with ACE inhibitors)

Many individuals will need more than one medication to achieve treatment goals, such as blood pressure control. It’s important to seek medical advice from your healthcare provider to evaluate the best treatment options based on individual health needs and conditions.

The bottom line

Lisinopril treats high blood pressure and heart failure and can improve survival after a heart attack. It helps protect against kidney damage, particularly in hypertensive or diabetic patients. However, it can also cause kidney problems and increase potassium levels. These issues are usually reversible if the medication is stopped. It’s important to take lisinopril as directed and attend all appointments with your healthcare provider, including blood work or lab visits. This helps ensure the medication works as intended and allows for monitoring potential complications, such as changes in kidney function and potassium levels.