Late Onset Azotemia from RAAS Blockade in CKD Patients with Normal Renal Arteries and No Precipitating Risk Factors

Onuigbo, Macaulay; Onuigbo, Nnonyelum

doi:10.1080/08860220701742161

Cited by 23 publications

(41 citation statements)

References 44 publications

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“…28 Details of these patients have been variously described in the literature. [25][26][27][28] In summary, 100 Caucasian CKD patients were enrolled. At enrollment, there were 52 males, 48 females, mean age 71.5 (25-92) years.…”

Section: Methodsmentioning

confidence: 99%

“…The details of the 100-patient cohort have been recorded in our previous reports. [25][26][27][28] In summary, all 100 patients were recruited over a 30-month period between September 2002 and March 2005. They included all patients presenting with ≥25% increase in baseline serum creatinine over the preceding 3 months or less, and who were concurrently on an ACE inhibitor, an angiotensin receptor blocker (ARB), or both.…”

Section: Methodsmentioning

confidence: 99%

“…We have variously reported on this cohort in the past publications. [25][26][27][28] We conducted an analysis of the pattern of CKD progression to ESRD in this cohort, an 82-month prospective review of a practice-based research network-based (PBRN-based) patient-level data in July 2009.…”

Section: Syndrome Of Rapid-onset Esrd 955mentioning

confidence: 99%

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Syndrome of rapid-onset end-stage renal disease: a new unrecognized pattern of CKD progression to ESRD

Onuigbo¹

2010

Renal Failure

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By most estimates, we have an increasing worldwide end-stage renal disease (ESRD) epidemic. This is despite at least two decades of intensified reno-protection strategies, including attempts at optimal hypertension management, optimization of diabetic control, smoking cessation efforts, and the extensive application of renin-angiotensin-aldosterone system (RAAS) blockade in both diabetic and nondiabetic chronic nephropathies. The current consensus is that chronic kidney disease (CKD) progression to ESRD is a continuous, progressive, and predictable loss of estimated glomerular filtration rate (eGFR) in CKD patients, inexorably leading to ESRD. Our recent experience in a Mayo Health System Hypertension Clinic, as well as new reports associating ESRD development in CKD patients with episodes of acute kidney injury (AKI), led us to hypothesize that CKD to ESRD progression may not be that predictable, after all. Among a 100 high-risk CKD patient cohort that we have followed up prospectively since 2002, we demonstrated that in 15 of 17 (88%) patients who progressed to ESRD, progression from CKD to ESRD was unpredictable, nonlinear, abrupt, and rapid, and this followed AKI secondary to medical and surgical events. We have coined a new term, the syndrome of rapid-onset end-stage renal disease (SORO-ESRD), to represent this unrecognized syndrome. Larger studies are warranted to confirm our single-center findings. If confirmed to represent a significant proportion of the ESRD population, at least here in the United States, this finding will demand major paradigm shifts in the current concepts of reno-protection and "A-V Fistula first" programs.

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Section: Methodsmentioning

confidence: 99%

Section: Methodsmentioning

confidence: 99%

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Syndrome of rapid-onset end-stage renal disease: a new unrecognized pattern of CKD progression to ESRD

Onuigbo¹

2010

Renal Failure

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“…The risk of mortality in patients aged ≥ 80 years increased when systolic blood pressure was < 140 mmHg or diastolic blood pressure < 70 mmHg [25] . Although it has been documented that antihypertensive treatment in the oldest old was associated with a reduction in the frequency of strokes and major cardiac events, there was however no benefit in cardiovascular death nor in general mortality [26] . Furthermore, the evidencebase provided by several studies (INVEST, STONE, HYVET) is reassuring regarding targeting relatively higher blood pressure levels in the very elderlyblood pressure target < 15080 mmHgalthough these aforementioned studies did not specifically address CKD patients [25] .…”

Section: Blood Pressurementioning

confidence: 86%

Nephroprevention in the oldest old with chronic kidney disease: Special considerations

Musso

Vilas

Onuigbo

2015

WJN

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Nephroprevention strategies are crucial for handling chronic kidney disease (CKD) complications, and slowing its progression. However, these preventative measures should be guided by major geriatrics principles in order to help nephrologists to adequately handle the oldest old with CKD. These geriatric concepts consist of taking into account the relevance of choosing an individualized therapy, handling clinical frailty, and keeping a geriatric perspective which means that a good quality of life is sometimes a more important therapeutic objective in octogenarians than merely prolonging life. Even though nephroprevention strategies for treating the oldest old with CKD are basically similar to those applied to younger patients such as low sodium and protein diet, optimized hemoglobin levels, blood pressure and metabolic control, the treating physician or care provider must at all times be ready to make fundamental adjustments and tweak patient care paradigms and objectives if and when the initial therapeutic options applied have caused unintended clinical consequences and complications. Additionally, the sarcopenia status should also be evaluated and treated in very old CKD patients. Core tip: Even though nephroprevention in the oldest old is basically similar to those applied to younger patients, it should be performed applying a geriatric perspective, where good quality of life is sometimes a more important therapeutic objective than merely prolonging life.Musso CG, Vilas M, Onuigbo M. Nephroprevention in the oldest old with chronic kidney disease: Special considerations. World

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“…Since our first report of the syndrome of LORFFAB in 2005, over the last ten or more years, we have variously described the features of this syndrome in various journal publications, book chapters and editorial pieces as well as in professional academic intellectual forums and presentations (1)(2)(3)(4)(5)(6). It was indeed our work at the Mayo Clinic Health System in Northwestern Wisconsin that spurred the work of El Nahas and his group from the Sheffield Kidney Institute, Sheffield in the United Kingdom who concluded in 2010 that discontinuation of ACEI/ARB had undoubtedly delayed the onset of RRT in the majority of those studied and that this observation might justify a rethink of our approach to the inhibition of the renin-angiotensin-aldosterone system (RAAS) in patients with advanced CKD who are nearing the start of RRT (11,12).…”

Section: Discussionmentioning

confidence: 99%

Late onset renal failure from angiotensin blockade (LORFFAB) and the syndrome of rapid onset endstage renal disease (SORO-ESRD) revisited – Two case reports from Mayo Clinic Health System, Northwestern Wisconsin, USA; a review paper

Onuigbo¹,

Samuel²,

Agbasi³

2018

J Renal Inj Prev

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In 2005, we had described for the first time, the syndrome of late onset renal failure from angiotensin blockade (LORFFAB), represented by the observed accelerated loss of kidney function in patients on a priori stable doses of an angiotensin converting enzyme inhibitor and/or an angiotensin receptor blocker, for more than three months, with this acute kidney injury (AKI) occurring despite the absence of any identifiable known precipitating factors. Moreover, in 2010, we had described the syndrome of rapid onset end-stage renal disease (SORO-ESRD), represented by acute yet irreversible renal failure following medical illness or surgical procedures, again sometimes in association with concurrent angiotensin blockade. In this article, we describe two representative case reports, one each of both syndromes, and discuss the implications of LORFFAB and SORO-ESRD in current nephrology practice paradigms.Please cite this paper as: Onuigbo M, Samuel E, Agbasi N. Late onset renal failure from angiotensin blockade (LORFFAB) and the syndrome of rapid onset end-stage renal disease (SORO-ESRD) revisited -Two case reports from Mayo Clinic Health System, Northwestern Wisconsin, USA; a review paper. J Renal Inj Prev. 2018;7(2):58-63. DOI: 10.15171/jrip.2018.15. In 2005, we described for the first time, the syndrome of late onset renal failure from angiotensin blockade (LORFFAB). This is accelerated loss of kidney function in patients on a priori stable doses of an angiotensin converting enzyme inhibitor and/or an angiotensin receptor blocker (ARB), for more than 3 months, with this acute kidney injury (AKI) occurring in the absence of any identifiable known precipitating factors. Moreover, in 2010, we described the syndrome of rapid onset end-stage renal disease (SORO-ESRD). This is acute yet irreversible renal failure following medical illness or surgical procedures, again sometimes in association with concurrent angiotensin blockade. In this article, we describe two representative case reports, one case for LORFFAB and another case for SORO-ESRD and subsequently discuss the implications of LORFFAB and SORO-ESRD in current nephrology practice paradigms. Whereas we support the consensus that angiotensin blockade, for now, remains the mainstay of renoprotection, we however must draw attention to the potential for nephrotoxicity from angiotensin blockade under certain clinical scenarios including the ones described here and more. The association of LORFFAB and SORO-ESRD demands further investigation.

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Late Onset Azotemia from RAAS Blockade in CKD Patients with Normal Renal Arteries and No Precipitating Risk Factors

Cited by 23 publications

References 44 publications

Syndrome of rapid-onset end-stage renal disease: a new unrecognized pattern of CKD progression to ESRD

Syndrome of rapid-onset end-stage renal disease: a new unrecognized pattern of CKD progression to ESRD

Nephroprevention in the oldest old with chronic kidney disease: Special considerations

Late onset renal failure from angiotensin blockade (LORFFAB) and the syndrome of rapid onset endstage renal disease (SORO-ESRD) revisited – Two case reports from Mayo Clinic Health System, Northwestern Wisconsin, USA; a review paper

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