# Enalapril or Benazepril for Dogs With Kidney Disease

Enalapril for dogs with kidney disease is an ACE inhibitor, a blood pressure medication that lowers the pressure inside the kidney filters and reduces protein leaking into the urine. It does not cure kidney disease, but it can slow the damage that high filtration pressure causes over time. Benazepril is a close cousin in the same drug family and is used for the same reasons.

This article is educational and is not a substitute for veterinary diagnosis or treatment.

## Quick Answer

- ACE inhibitors like enalapril and benazepril are used in canine chronic kidney disease (CKD) because they block angiotensin II, the hormone that drives high pressure and high flow inside the remaining kidney filters [1].
- They are most clearly helpful in dogs with protein in the urine (proteinuria), which is a hallmark of glomerular disease and a common cause of CKD in dogs [2].
- Your veterinarian stages CKD using creatinine and SDMA, then substages it using urine protein:creatinine ratio and systolic blood pressure [3].
- Kidney values are usually rechecked about 1 to 2 weeks after starting an ACE inhibitor, because these drugs can worsen renal function in some dogs [4].
- Expect a mild, stable rise in kidney values in some dogs. A large or progressive rise needs veterinary attention.

## What Is Happening Inside the Kidney?

Chronic kidney disease means the kidneys have lost working nephrons (the tiny filtering units) and cannot fully recover them. As nephrons are lost, the survivors take on extra work. Blood flow and pressure inside each remaining filter go up, which keeps filtration going in the short term but damages the filters in the long term [1].

The hormone angiotensin II controls much of that extra pressure. It also raises levels of transforming growth factor-beta (TGF-β), a signal that drives scar tissue to build up in the kidney [1]. That scarring means more nephron loss, which means more pressure on the filters that remain. It becomes a cycle.

Glomerular disease is a separate but overlapping problem. In glomerular disease, the structure or function of the glomerulus (the filter itself) is altered, and the hallmark sign is proteinuria, which can be severe [2]. Glomerular disease often causes CKD or occurs alongside it, and it is a well-recognized cause of CKD in dogs [2].

## What You Will Notice at Home

Early kidney disease is often silent. You may notice nothing at all, and the problem turns up on routine bloodwork.

When signs do appear, owners commonly report:

- Drinking more water and urinating more
- Accidents in the house in a previously reliable dog
- Weight loss and a duller coat
- Reduced appetite, sometimes with vomiting
- Weakness or tiredness on walks

Proteinuria itself has no visible sign. You cannot see protein in the urine, so it is found on testing, not by watching your dog. Some dogs with kidney disease also develop mouth odor, which is covered in our article on [Dog Bad Breath Kidney Disease](/knowledge/veterinary-medicine/dental-care/dog-bad-breath-kidney-disease) and its companion piece on [Dog Bad Breath Kidney Disease Treatment](/knowledge/veterinary-medicine/dental-care/dog-bad-breath-kidney-disease-treatment).

## Causes and Risk Factors

Anything that destroys nephrons can lead to CKD. Common contributors include age-related wear, infections, toxins, dental disease, and immune-mediated damage to the glomerulus. Glomerular disease deserves special mention because it is the group most likely to benefit from an ACE inhibitor [2].

Risk factors your veterinarian will weigh:

- Proteinuria. The more protein in the urine, the more reason to treat.
- High systolic blood pressure. Pressure and protein loss tend to travel together.
- Breed. Some breeds are overrepresented in glomerular disease, though the specific list is not well established in published veterinary research.
- Age. CKD becomes more common as dogs get older.
- Existing heart disease. Many dogs on enalapril for heart problems also have kidney concerns, and the drug is used in both settings [5].

## How Veterinarians Diagnose and Stage Kidney Disease

Diagnosis starts with bloodwork and a urine test. Your veterinarian measures creatinine and SDMA to stage CKD, and staging is based on at least two assessments in a stable, hydrated patient after food has been withheld [3].

Then comes substaging, which is where ACE inhibitors enter the picture:

- Proteinuria substage, using the urine protein:creatinine ratio. Ideally this is based on at least two urine samples collected at least 2 weeks apart [3].
- Blood pressure substage, using systolic arterial blood pressure. Because stress can falsely raise readings, multiple measurements are ideally taken on at least two separate days, though several readings during one visit separated by at least 2 hours are also acceptable [3].

A renal biopsy may be recommended to characterize the exact type of glomerular disease when it is practical to do so [2]. Your veterinarian will also look for underlying triggers and for the consequences of protein loss, such as low blood albumin [2].

### Staging and Substaging at a Glance

| Test | What it measures | Why it matters for ACE inhibitor decisions |
|---|---|---|
| Creatinine and SDMA | Overall kidney function | Sets the CKD stage, based on two stable, fasted samples [3] |
| Urine protein:creatinine ratio | Protein leaking through the filter | Identifies proteinuria, the main reason to start an ACE inhibitor [3] |
| Systolic blood pressure | Pressure in the arteries | High pressure raises the risk of target organ damage and guides treatment [3] |
| Renal biopsy | Tissue structure of the glomerulus | Characterizes the type of glomerular disease when practical [2] |

## Treatment Options: Enalapril and Benazepril

### Why ACE Inhibitors Are Used

ACE inhibitors were originally approved for congestive heart failure in dogs, but they may also help manage dogs with CKD [1]. The logic is straightforward. If angiotensin II drives the high pressure and high flow that destroy remaining nephrons, blocking its production should ease that pressure and slow the cycle [1].

In dogs with proteinuric CKD, blocking the renin-angiotensin-aldosterone system reduces pressure inside the glomerulus and is considered standard therapy [6]. That is the core reason your veterinarian reaches for this drug class.

### Enalapril for Dogs With Kidney Disease

Enalapril is the more familiar of the two in general practice. In a study of dogs with proteinuric CKD, enalapril was dosed at 0.5 mg/kg by mouth every 12 hours [7][6]. That is a research dose, not a prescription. Your veterinarian calculates the dose from your dog's weight, kidney stage, blood pressure, and other medications.

One thing owners should understand: ACE inhibitors can acutely decrease glomerular filtration rate [6]. In plain words, the drug lowers pressure inside the filter, and filtration can dip a little as a result. That is expected, and it is why recheck bloodwork matters.

### Benazepril for Dogs With Kidney Disease

Benazepril is the other common ACE inhibitor in this family. It is a prodrug, meaning the body converts it into its active form, benazeprilat [8]. Benazepril is commonly prescribed in dogs with heart disease to damp down the renin-angiotensin-aldosterone system [8].

Benazepril's effects are dose dependent. In healthy dogs, a dose of 0.5 mg/kg produced lower time-weighted average values for RAAS biomarkers than a dose of 0.125 mg/kg [8]. A fixed-dose combination of benazepril and spironolactone has also been studied, and higher doses produced greater suppression of RAAS biomarkers than the label dose [9]. Again, these are study doses. Your veterinarian sets the actual dose.

### Which One Is Better?

There is no head-to-head study in published veterinary research showing that one is clearly superior for canine kidney disease. Both are ACE inhibitors used for the same purpose. In practice, the choice often comes down to what your veterinarian is most experienced with, what formulation is easiest to give your dog, cost, and whether your dog is already on one of them for heart disease.

### Other Treatments That Work Alongside the Drug

ACE inhibitors are one part of a plan, not the whole plan. Your veterinarian may also recommend:

- A kidney-supportive diet, which we cover in [Dog Kidney Disease Diet](/knowledge/veterinary-medicine/nutrition/dog-kidney-disease-diet)
- Blood pressure medication such as amlodipine when hypertension is severe. In one study, some dogs received amlodipine alongside their RAAS inhibitor for that reason [6].
- Dietary and drug strategies aimed at reducing proteinuria, since treatment of glomerular disease includes both pharmacological and dietary intervention [2]
- Treatment of any underlying trigger when the cause is known [2]

For a deeper look at staging and how the whole plan fits together, see [Canine Chronic Kidney Disease: Staging and Therapeutic Plan](/knowledge/veterinary-medicine/clinical-internal-medicine/canine-chronic-kidney-disease-staging-therapeutic-plan).

## Recheck Bloodwork: What to Expect

This is the part owners ask about most, and it is the part that matters most for safety.

Reevaluation of renal function is recommended 1 to 2 weeks after starting ACE inhibitor therapy, because these drugs have the potential to cause worsening renal function [4]. Do not skip this visit even if your dog seems fine.

In a study of 156 dogs receiving ACE inhibitors for heart disease, proteinuria, or systemic hypertension, worsening renal function was graded by how far serum creatinine rose from the starting value. Grade 1 was a rise of at least 0.3 mg/dL with creatinine staying at or below 1.6 mg/dL. Grade 2 was a rise to 1.7 to 2.5 mg/dL. Grade 3 was a rise to 2.6 to 5.0 mg/dL [4]. Your veterinarian will use a similar framework to decide whether to continue, adjust, or stop the drug.

What gets checked at rechecks:

- Serum creatinine, to compare against the starting value [4]
- SDMA, a marker of glomerular filtration rate. In dogs with proteinuric CKD treated with a RAAS inhibitor, SDMA, creatinine, and urea nitrogen were measured before treatment and again at 7 and 30 days [6].
- Blood pressure, since pressure substaging guides therapy [3]
- Urine protein:creatinine ratio, to see whether protein loss is falling
- Electrolytes and general chemistry, which are part of the standard panel in these cases [4]

A small, stable rise in creatinine is common and often acceptable. A large rise, or a rise that keeps climbing, is a signal to reassess.

## Recovery, Outlook, and Long-Term Management

There is no cure for CKD, and ACE inhibitors do not reverse existing damage. The realistic goal is slowing progression and controlling protein loss and blood pressure.

Outlook depends heavily on stage at diagnosis, how much protein is in the urine, blood pressure control, and how well your dog eats. Dogs with severe proteinuria tend to have a more guarded long-term outlook, which is why early detection through urine testing matters so much.

Long-term management usually means:

- Lifelong medication, given on a consistent schedule
- Recheck bloodwork and urine testing at intervals your veterinarian sets, often more often right after a dose change
- A kidney diet and fresh water available at all times
- Monitoring body weight, appetite, and energy at home, and reporting changes early
- Watching for neurologic signs. If your dog develops head tremors or unusual head movements, see [Dog Shaking Head Kidney Disease](/knowledge/veterinary-medicine/clinical-methods/dog-shaking-head-kidney-disease).

## Prevention

You cannot prevent all kidney disease, but you can catch it earlier.

- Ask for a urine protein test at annual wellness visits, especially for older dogs and breeds prone to glomerular disease.
- Ask for blood pressure measurement. It is quick and it changes treatment decisions [3].
- Keep dental disease under control, since chronic inflammation and infection can affect the kidneys.
- Avoid unsupervised access to human medications, especially NSAIDs, and to toxins.
- Keep your dog at a healthy weight and manage any heart disease closely, since heart and kidney care often overlap [5].

## Limitations and When to Contact a Veterinarian

ACE inhibitors can cause worsening renal function, which is exactly why the 1 to 2 week recheck is recommended [4]. Never start, stop, or change the dose on your own.

Contact your veterinarian the same day if you notice:

- Vomiting, diarrhea, or refusal to eat after starting the medication
- Marked lethargy or weakness
- Your dog drinking or urinating far more than before
- You missed several doses and are unsure how to restart

Go to an emergency clinic now if your dog:

- Collapses or cannot stand
- Has a seizure or severe disorientation
- Is breathing hard at rest
- Cannot keep any water down

Schedule a routine visit if:

- Your dog's breath smells strongly of ammonia or urine
- You see weight loss over weeks
- Your dog's water intake has crept up gradually
- It has been more than 6 months since the last kidney panel

Every dog is different. Dosing, monitoring intervals, and whether an ACE inhibitor is even the right choice for your dog need to be decided by your own veterinarian who examines your pet and reviews the lab work.

## Frequently Asked Questions

### Is enalapril safe for dogs with kidney disease?

It is commonly used and considered standard therapy for dogs with proteinuric CKD, but it is not risk-free [6]. ACE inhibitors can lower filtration and worsen renal function in some dogs, so a recheck 1 to 2 weeks after starting is recommended [4]. Your veterinarian decides whether the benefit outweighs that risk for your dog.

### Does enalapril cure kidney disease in dogs?

No. It does not restore lost nephrons or reverse scarring. What it does is block angiotensin II, the hormone that drives the high pressure and scarring cycle inside the remaining filters [1]. The goal is to slow progression, not to cure the disease.

### Can my dog take enalapril and benazepril together?

No, they are the same class of drug and are used as alternatives to each other, not in combination. Your veterinarian will pick one. If your dog is already on benazepril for heart disease, that same drug may be continued for kidney reasons instead of switching.

### How often does my dog need bloodwork while on an ACE inhibitor?

Expect a recheck about 1 to 2 weeks after starting or after any dose change [4]. After that, the interval depends on your dog's stage and stability, and your veterinarian sets it. Some dogs need checks every few months, others more often.

### What if the kidney values go up after starting the medication?

A mild rise can be acceptable and may simply reflect the drug lowering pressure inside the filter, since ACE inhibitors can acutely decrease glomerular filtration rate [6]. A larger rise, graded by how far creatinine climbs, may mean the dose needs adjusting or the drug needs to stop [4]. Call your veterinarian with the numbers instead of deciding on your own.

<script type="application/ld+json">
{
  "@context": "https://schema.org",
  "@type": "FAQPage",
  "mainEntity": [
    {
      "@type": "Question",
      "name": "Is enalapril safe for dogs with kidney disease?",
      "acceptedAnswer": {
        "@type": "Answer",
        "text": "It is commonly used and considered standard therapy for dogs with proteinuric CKD, but it is not risk-free . ACE inhibitors can lower filtration and worsen renal function in some dogs, so a recheck 1 to 2 weeks after starting is recommended . Your veterinarian decides whether the benefit outweighs that risk for your dog."
      }
    },
    {
      "@type": "Question",
      "name": "Does enalapril cure kidney disease in dogs?",
      "acceptedAnswer": {
        "@type": "Answer",
        "text": "No. It does not restore lost nephrons or reverse scarring. What it does is block angiotensin II, the hormone that drives the high pressure and scarring cycle inside the remaining filters . The goal is to slow progression, not to cure the disease."
      }
    },
    {
      "@type": "Question",
      "name": "Can my dog take enalapril and benazepril together?",
      "acceptedAnswer": {
        "@type": "Answer",
        "text": "No, they are the same class of drug and are used as alternatives to each other, not in combination. Your veterinarian will pick one. If your dog is already on benazepril for heart disease, that same drug may be continued for kidney reasons instead of switching."
      }
    },
    {
      "@type": "Question",
      "name": "How often does my dog need bloodwork while on an ACE inhibitor?",
      "acceptedAnswer": {
        "@type": "Answer",
        "text": "Expect a recheck about 1 to 2 weeks after starting or after any dose change . After that, the interval depends on your dog's stage and stability, and your veterinarian sets it. Some dogs need checks every few months, others more often."
      }
    },
    {
      "@type": "Question",
      "name": "What if the kidney values go up after starting the medication?",
      "acceptedAnswer": {
        "@type": "Answer",
        "text": "A mild rise can be acceptable and may simply reflect the drug lowering pressure inside the filter, since ACE inhibitors can acutely decrease glomerular filtration rate . A larger rise, graded by how far creatinine climbs, may mean the dose needs adjusting or the drug needs to stop . Call your veterinarian with the numbers instead of deciding on your own."
      }
    }
  ]
}
</script>

## Related Articles

- [Dog Kidney Disease Diet](/knowledge/veterinary-medicine/nutrition/dog-kidney-disease-diet)
- [Dog Bad Breath Kidney Disease Treatment](/knowledge/veterinary-medicine/dental-care/dog-bad-breath-kidney-disease-treatment)
- [Dog Bad Breath Kidney Disease](/knowledge/veterinary-medicine/dental-care/dog-bad-breath-kidney-disease)
- [Canine Chronic Kidney Disease: Staging and Therapeutic Plan](/knowledge/veterinary-medicine/clinical-internal-medicine/canine-chronic-kidney-disease-staging-therapeutic-plan)
- [Dog Shaking Head Kidney Disease](/knowledge/veterinary-medicine/clinical-methods/dog-shaking-head-kidney-disease)
- [Canine Renal Dysplasia: Diagnosis and Management](/knowledge/veterinary-medicine/clinical-methods/canine-renal-dysplasia-diagnosis-management)
- [Enalapril for Dogs: Side Effects and What It Does](/knowledge/veterinary-medicine/pet-medication-guide/enalapril-dogs-side-effects)
- [Benazepril for Dogs: Side Effects, Dosage and Monitoring](/knowledge/veterinary-medicine/pet-medication-guide/benazepril-dogs-side-effects)
- [High Blood Pressure and Kidney Disease in Dogs](/knowledge/veterinary-medicine/senior-and-chronic-care/high-blood-pressure-kidney-disease-dogs)

## References

1. [Pharmacotherapeutics in Glomerular Diseases in Animals - Pharmacology](https://www.merckvetmanual.com/pharmacology/systemic-pharmacotherapeutics-of-the-urinary-system/pharmacotherapeutics-in-glomerular-diseases-in-animals). Merck Veterinary Manual.
2. [Glomerular Disease in Dogs and Cats - Urinary System](https://www.merckvetmanual.com/urinary-system/noninfectious-diseases-of-the-urinary-system-in-small-animals/glomerular-disease-in-dogs-and-cats). Merck Veterinary Manual.
3. [Renal Dysfunction in Dogs and Cats - Urinary System](https://www.merckvetmanual.com/urinary-system/noninfectious-diseases-of-the-urinary-system-in-small-animals/renal-dysfunction-in-dogs-and-cats). Merck Veterinary Manual.
4. [Retrospective evaluation of risk factors for worsening renal function after angiotensin-converting enzyme inhibitor treatment in dogs](https://pubmed.ncbi.nlm.nih.gov/39564763/). Journal of veterinary internal medicine, 2025.
5. [Impact of a combination of pimobendan, furosemide, and enalapril on heart rate variability in naturally occurring, symptomatic, myxomatous mitral valve degeneration dogs](https://pubmed.ncbi.nlm.nih.gov/37821927/). BMC veterinary research, 2023.
6. [Serum symmetric dimethylarginine concentrations in enalapril- or telmisartan-treated dogs with proteinuric chronic kidney disease](https://pubmed.ncbi.nlm.nih.gov/39711803/). Frontiers in veterinary science, 2024.
7. [Characterization of the circulating markers of the renin-angiotensin-aldosterone system in telmisartan- or enalapril-treated dogs with proteinuric chronic kidney disease](https://pubmed.ncbi.nlm.nih.gov/39206534/). Journal of veterinary internal medicine, 2024.
8. [Dose-response of benazepril on biomarkers of the classical and alternative pathways of the renin-angiotensin-aldosterone system in dogs](https://pubmed.ncbi.nlm.nih.gov/36792677/). Scientific reports, 2023.
9. [Dose-exposure-response of CARDALIS® (benazepril/spironolactone) on the classical and alternative arms of the renin-angiotensin-aldosterone system in healthy dogs](https://pubmed.ncbi.nlm.nih.gov/39601373/). Journal of veterinary internal medicine, 2025.

## Further Reading

- [American Veterinary Medical Association: First Aid Tips for Pet Owners](https://www.avma.org/resources-tools/pet-owners/emergencycare/first-aid-tips-pet-owners)
- [Merck Veterinary Manual: Dog Owners](https://www.merckvetmanual.com/dog-owners)
- [Cornell Richard P. Riney Canine Health Center: Canine Health Information](https://www.vet.cornell.edu/departments-centers-and-institutes/riney-canine-health-center/canine-health-information)