Captopril-Induced Acute Reversible Renal Failure

Abstract

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.

Single-Dose Captopril Scintigraphy in the Neonate with Renovascular Hypertension: Prediction of Renal Failure, a Side Effect of Captopril Therapy

“…However, serious morbidity and mortality have been attrib uted to thromboembolic catheter complica tions including renovascular hypertension (RVH) [1,2], RVH frequently complicates renal infarction or renal ischemia from thromboembolism of a branch or the entire renal artery(ies) or of the aorta [3], and is the result of hypersecretion of renin from the kidney(s) as a compensatory mechanism to maintain glomerular filtration [4,5], The converting enzyme inhibitors (CEI), capto pril (CAP) and enalapril, are effective in hyperreninemic hypertension and have been introduced in the treatment of neonatal RVH [6]. However, in patients with RVH due to an ischemic single kidney or with RVH due to bilateral renal ischemia from renal artery stenosis, treatment with CEI may induce renal failure by decompensating the ischemic kidney(s) [7,8], This complica tion is reversible and persists while the drug is circulating. Recognition of this complica tion and prompt discontinuation of the drug restores renal function [7][8][9], Likewise, in the neonate with RVH, renal ischemia may involve a single functioning kidney, or it can be bilateral.…”

“…However, in patients with RVH due to an ischemic single kidney or with RVH due to bilateral renal ischemia from renal artery stenosis, treatment with CEI may induce renal failure by decompensating the ischemic kidney(s) [7,8], This complica tion is reversible and persists while the drug is circulating. Recognition of this complica tion and prompt discontinuation of the drug restores renal function [7][8][9], Likewise, in the neonate with RVH, renal ischemia may involve a single functioning kidney, or it can be bilateral. We have used renal scintigraphy as a baseline (BSL) and after the first dose of CAP to investigate neonates with hyperten sion in an effort to diagnose and lateralize RVH due to renal infarction or ischemia and predict the development of CEI-induced re nal failure.…”

Low-dose enalapril in severe chronic heart failure

“…Recently, enalapril has been established in long-term therapy because of its longer half-life and its more gradual onset of action [19][20][21][22][23][24]. The potential risks of the hitherto conventional high-dosage angiotensin-converting enzyme inhibitors are recognized [25][26][27][28][29], particularly the detrimental effects of long-acting enalapril on renal function [30]. Only one study tried to reduce the dosage to 10 mg/day, and it was successful [4].…”

Captopril and Kidney Function in Renovascular and Essential Hypertension

“…However, blockade of angiotensin-converting enzyme may lead to an impairment of kidney function in patients with reno vascular hypertension, especially in those with bilateral renal artery stenosis or renal artery stenosis in a solitary kidney [4][5][6]. There are different possible pathomechanisms of this renal insufficiency, the most important of which is probably an interference of captopril with intrarenal regulation of glomerular filtration mediated by angiotensin II in the presence of reduced renal artery perfusion pressure [6,8].…”

“…Numerous reports have con firmed its efficacy in various forms of hypertension [1-3], However, there is an increasing number of studies report ing a captopril-induced impairment of kidney function in patients with renovascular hypertension, especially in those with bilateral renal artery stenosis or with renal artery stenosis in a solitary kidney [4][5][6].…”