Deterioration in renal function associated with angiotensin converting enzyme inhibitor therapy is not always reversible

Devoy, M. A. B.; Tomson, Charles; Edmunds, Matthew R.; Feehally, John; Walls, John

doi:10.1111/j.1365-2796.1992.tb00622.x

Cited by 52 publications

(43 citation statements)

References 23 publications

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“…ARF in association with ACE inhibitor therapy typically reverses with discontinuation of the ACE inhibitor or volume repletion, although occasionally, recovery is delayed or does not occur. 48,49 …”

Section: Arf Due To Ace Inhibitor Therapymentioning

confidence: 99%

Renal Considerations in Angiotensin Converting Enzyme Inhibitor Therapy

Schoolwerth¹,

Sica²,

Ballermann³

et al. 2001

Circulation

311

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Section: Arf Due To Ace Inhibitor Therapymentioning

confidence: 99%

Renal Considerations in Angiotensin Converting Enzyme Inhibitor Therapy

Schoolwerth¹,

Sica²,

Ballermann³

et al. 2001

Circulation

311

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“…6 Although ACE-I are considered safe in the presence of renal failure, 7 episodes of acute decreases in renal function have been reported. [8][9][10] Particularly in low-flow states, as in the presence of renal artery stenosis or volume depletion, acute declines in glomerular filtration rate (GFR) and impairment of potassium excretion may occur. The effect on GFR has been shown to be mediated by bradykinin, levels of which are increased by ACE-I, but are unaffected by ARBs.…”

Section: Introductionmentioning

confidence: 99%

Evaluation of the safety and efficacy of telmisartan and enalapril, with the potential addition of frusemide, in moderate-renal failure patients with mild-to-moderate hypertension

Hannedouche

Chanard

Baumelou

2001

J Renin Angiotensin Aldosterone Syst

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The effect on renal function and efficacy of the angiotensin II AT 1 -receptor blocker (ARB), telmisartan, were compared with those of the angiotensin-converting enzyme inhibitor, enalapril, for the treatment of mild-tomoderate hypertension (diastolic blood pressure [DBP] 95-114 mmHg) in the presence of moderate renal failure (creatinine clearance [Ccr] 30-80 ml/minute). The study was multicentre, double-blind, double-dummy and active-controlled in design, with patients randomised in a 2:1 ratio to receive telmisartan or enalapril. After a two-week placebo run-in period, the 71 eligible patients received either telmisartan, 40 mg, or enalapril, 10 mg, once-daily for four weeks. Thereafter, doses were titrated to telmisartan 80 mg or enalapril 20 mg once-daily if supine trough DBP was still ≥90 mmHg. After a further four weeks, dose titration was again performed, as required, to telmisartan, 80 mg, or enalapril, 20 mg, or frusemide was given in addition if the double dose was already being administered. Mean Ccr decreases of 4.6% for telmisartan and 2.8% for enalapril were not clinically significant. Adverse events occurred in 12 (26.7%) telmisartan-treated patients and in 12 (46.2%) patients receiving enalapril. The mean reduction in supine trough DBP from baseline to the last available value was 12.5 mmHg for telmisartan, compared with 11.9 mmHg for enalapril. A full (reduction of ≥10 mmHg) or partial (reduction of 7-9 mmHg) response occurred in 78% of telmisartan patients and 65% of enalapril patients. In the enalapril group, 43% of patients required frusemide, compared with 29% of those in the telmisartan group. In conclusion, telmisartan lacks detrimental effect on renal function, is effective in the treatment of mild-to-moderate hypertension in patients with moderate renal failure, and is comparable to enalapril.

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“…The use of ACEIs in patients with kidney disease can also cause renal excretory function to decrease 13, 16, 31, 32. SCr and urea did not change significantly in group‐MD or RD and remained within the reference range in all but 1 dog in group‐RD, which presented with mild azotemia and concentrated urine at D60.…”

Section: Discussionmentioning

confidence: 97%

Evaluation of the Effects of a Therapeutic Renal Diet to Control Proteinuria in Proteinuric Non‐Azotemic Dogs Treated with Benazepril

Cortadellas

Talavera

Palacio

2013

Veterinary Internal Medicne

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BackgroundAngiotensin‐converting enzyme inhibitors (ACEIs) are currently used to control proteinuria in dogs with chronic kidney disease. Renal diets (RDs) have beneficial effects in the management of azotemic dogs, but its role in proteinuric non‐azotemic (PNAz) dogs has been poorly documented.HypothesisAdministration of a RD to PNAz dogs treated with benazepril (Be) improves proteinuria control compared with the administration of a maintenance diet (MD).AnimalsTwenty‐two PNAz (urine protein/creatinine ratio [UPC] >1) dogs.MethodsRandomized open label clinical trial design. Dogs were assigned to group‐MD (5.5 g protein/100 kcal ME)/Be or to group‐RD (3.7 g protein/100 kcal ME)/Be group during 60 days. Dogs with serum albumin (Alb) <2 g/dL received aspirin (1 mg/kg/12 hours). A physical examination, systolic blood pressure (SBP) measurement, complete blood count (CBC), biochemistry panel, urinalysis, and UPC were performed at day 0 (D0) and day 60 (D60).ResultsAt D0, there were no significant differences between groups in the evaluated variables. During the study, logUPC (geometric mean (95% CI) and SBP (mean±SD mmHg) significantly decreased (paired t‐test, P = 0.001) in Group‐RD (logUPCD0 = 3.16[1.9–5.25]; UPCD60 = 1.20 [0.59–2.45]; SBPD0 = 160 ± 17.2; SBPD60 = 151 ± 15.8), but not in Group‐MD (UPCD0 = 3.63[2.69–4.9]; UPCD60 = 2.14 [0.76–6.17]; SBPD0 = 158 ± 14.7; SBPD60 = 153 ± 11.5). However, RM‐ANOVA test did not confirm that changes were consequence of dietary modification. Weight and Alb concentration did not change significantly in any group.Conclusion and Clinical RelevanceThe administration of a RD to PNAz dogs treated with Be might help to control proteinuria and SBP compared with the administration of a MD, without inducing clinically detectable malnutrition, but more studies are warranted.

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Deterioration in renal function associated with angiotensin converting enzyme inhibitor therapy is not always reversible

Cited by 52 publications

References 23 publications

Renal Considerations in Angiotensin Converting Enzyme Inhibitor Therapy

Renal Considerations in Angiotensin Converting Enzyme Inhibitor Therapy

Evaluation of the safety and efficacy of telmisartan and enalapril, with the potential addition of frusemide, in moderate-renal failure patients with mild-to-moderate hypertension

Evaluation of the Effects of a Therapeutic Renal Diet to Control Proteinuria in Proteinuric Non‐Azotemic Dogs Treated with Benazepril

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