Acute renal failure, hemolytic anemia and skin rash associated with captopril therapy

Luderer, John R.; Schoolwerth, Anton C.; Sinicrope, Ronald A.; Ballard, James O.; Lookingbill, Donald P.; Hayes, Arthur H.

doi:10.1016/0002-9343(81)90187-x

Cited by 43 publications

(9 citation statements)

References 8 publications

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“…A similar coincidence between captopril administration and a fall in glomerular filtration rate has been reported in 8 other patients [Gavras et al, 1978;Farrow and Wilkinson, 1979;Collste et al, 1979;Woodhouse et al, 1979;Planz and Bundschu, 1980;Luderer et al, 1981;Hoorntje et al, 1982]. In 4 of these an immunoallergic mechanism was suggested by the presence of fever or skin rash, and in 1 patient patchy atrophy and inflammation were docu mented by renal biopsy .…”

Section: Discussionsupporting

confidence: 69%

Captopril-Induced Acute Reversible Renal Failure

Coulie¹,

Plaen²,

Strihou³

1983

Nephron

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We report 5 cases of acute reversible renal failure coinciding with the onset of treatment with captopril in patients with severe drug-resistant hypertension. There was no clinical or laboratory evidence for an immunologic or toxic insult, although in 1 patient we found a transient leukocyturia and mild proteinuria. A mere hypoperfusion of the kidney does not seem sufficient to account for all 5 observations: in 3 of them changes in blood pressure did not parallel changes in renal function. We propose that, in addition to hypoperfusion, captopril alters renal function by an additional intrarenal hemodynamic effect. The 5 patients had severe renovascular disease which might thus represent a significant risk factor in the development of captopril-induced acute renal failure.

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Section: Discussionsupporting

confidence: 69%

Captopril-Induced Acute Reversible Renal Failure

Coulie¹,

Plaen²,

Strihou³

1983

Nephron

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“…Rechallenge to captopril was not contemplated. Such reactions involving eosinophilia have been reported before though almost all associated with renal dysfunction (Pyrpasopoulos et al, 1983;Luderer et al, 1981;Steinman & Silva, 1983;Chrysant et al, 1983).…”

Section: Discussionmentioning

confidence: 79%

Captopril: 4 years of post marketing surveillance of all patients in New Zealand.

Beasley

et al. 1987

Brit J Clinical Pharma

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The Intensive Medicines Monitoring Programme (IMP), a specialised part of the New Zealand Post Marketing Surveillance system, has been used to monitor captopril since it was first approved for marketing for the treatment of hypertension and heart failure. Monitoring has consisted of (1) spontaneous reporting for which doctors have been encouraged to report all clinical events, (2) a specific event recording survey at the end of the first year and (3) a controlled patient survey of taste disturbance. The IMP gathers prescription information on about 85% of all patients. There were 4,124 patients at the end of the first 4 years. Reported events involved 4% of patients, the majority being cutaneous (1%) and gastrointestinal (0.7%). The event recording survey gave an overall rate of adverse events of 2.2 per patient year. The taste survey showed a remarkably high incidence of taste disturbance in the control population and only taste loss was significantly higher (P less than 0.01) for captopril. This ongoing study has so far demonstrated a low incidence of adverse effects due to captopril, which is reassuring in view of its increasing use for mild hypertension and early cardiac failure.

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“…Luderer et al [12] described a patient who devel oped acute renal failure 47 days after the initiation of captopril therapy. Skin rash, eosinophilia, and eosinophiluria were prominent features.…”

Section: Discussionmentioning

confidence: 99%

“…The clinical situations in which this occurs include (l) bilateral or unilateral renal artery stenosis in a solitary functioning kidney [5,6]; (2) congestive heart failure [7][8][9][10], and (3) the newborn period [11], In all of these circumstances reversible renal failure has been noted with ACE inhibitors as a class, and renal function improves within several days of either discontinuing the offending drug, stopping concomitant diuretics, or insti tution of volume expansion. Recent evidence suggests that ACE inhibitor mediated renal prostaglandin stimu lation may contribute to the decreased glomerular filtra tion rate by promoting a natriuresis with consequent vol ume depletion and by decreased renal plasma flow [6], Less frequently captopril, a sulfhydryl-containing ACE inhibitor, has been reported to induce an allergic interstitial nephritis with systemic features suggestive of a hypersensitivity reaction, including fever, a maculopapular rash, eosinophilia, and a Coombs-positive he- molytic anemia [12][13][14][15][16]. Only a few reported cases include renal biopsy material [13,14].…”

Section: Introductionmentioning

confidence: 99%

Captopril-Associated Acute Interstitial Nephritis

Smith¹,

Neill

Cushman³

et al. 1989

Am J Nephrol

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A 57-year-old male with mild impairment of renal function secondary to diabetic glomerulosclerosis developed acute renal failure (creatinine 32.4 mg/dl) associated with a generalized desquamative skin rash and peripheral eosinophilia shortly after initiation of antihypertensive therapy with captopril. An acute interstitial nephritis was demonstrated on renal biopsy, and improvement was temporally related to initiation of therapy with prednisone. A review of the literature revealed 5 similar cases in whom acute deterioration of renal function occurred following initiation of captopril and in whom there were features of a hypersensitivity reaction, including skin rash, fever, eosinophilia, azotemia, eosinophiluria, and a Coombs-positive hemolytic anemia. Renal biopsy, where available, revealed an acute interstitial nephritis. Observations from these cases suggest that, of the angiotensin-converting enzyme inhibitors, this syndrome appears to be specific for captopril, begins within the 1 st month of therapy, is not dose-dependent, and generally resolves on cessation of therapy. Steroids may hasten recovery, but sufficient data are not available to confirm their efficacy.

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Acute renal failure, hemolytic anemia and skin rash associated with captopril therapy

Cited by 43 publications

References 8 publications

Captopril-Induced Acute Reversible Renal Failure

Captopril-Induced Acute Reversible Renal Failure

Captopril: 4 years of post marketing surveillance of all patients in New Zealand.

Captopril-Associated Acute Interstitial Nephritis

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