Which of the following antihypeensive agents is contraindicated in patients with chronic renal disease?
**Core Concept**
The management of hypertension in patients with chronic renal disease requires careful consideration of the potential effects of antihypertensive agents on renal function. Certain classes of antihypertensive agents can worsen renal function or increase the risk of hyperkalemia in patients with chronic kidney disease.
**Why the Correct Answer is Right**
The correct answer is **Hydralazine**. Hydralazine is a direct vasodilator that can increase sodium and water reabsorption in the proximal tubule, leading to volume expansion and potentially worsening renal function in patients with chronic kidney disease. Additionally, hydralazine can increase the risk of hyperkalemia due to its effect on the renin-angiotensin-aldosterone system.
**Why Each Wrong Option is Incorrect**
* **Option A:** Captopril is an angiotensin-converting enzyme (ACE) inhibitor, which is actually beneficial in patients with chronic kidney disease as it can reduce proteinuria and slow the progression of renal disease.
* **Option B:** Amlodipine is a calcium channel blocker that is generally well-tolerated in patients with chronic kidney disease and can be used to manage hypertension in these patients.
* **Option D:** Lisinopril is another ACE inhibitor that is commonly used to treat hypertension in patients with chronic kidney disease.
**Clinical Pearl / High-Yield Fact**
ACE inhibitors, such as captopril and lisinopril, are generally contraindicated in patients with bilateral renal artery stenosis or unilateral renal artery stenosis in a solitary kidney due to the risk of acute kidney injury.
**Correct Answer:** C. Hydralazine