Zunehmende Niereninsuffizienz nach Blutdrucksenkung mit Captopril bei maligner Hypertonie

Abstract

In a 25-year-old woman with malignant hypertension based on primary nephrosclerosis, captopril, an oral inhibitor of angiotension I-converting enzyme, lowered blood pressure effectively, which had been resistant previously to other oral antihypertensive drugs. Concomitantly with the decrease of the high blood pressure, an increase of creatinine from 2.1 mg% to 8.5 mg% occurred. There is evidence that this increase of renal failure is a consequence of blood pressure reduction and is not caused by a toxic effect of captopril.

Captopril-Induced Acute Reversible Renal Failure

“…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 .…”

“…Support for this hypothesis was provided by similar observations of renal failure follow ing the administration of vasodilating hypotensive drugs such as minoxidil [Collste et al, 1979] and nitroprusside [Planz and Bundschu, 1980]. Reversal of renal failure in patient 3, when blood pressure returned to control values despite continuation of captopril, is in agreement with this hypothesis.…”

“…Such a phenomenon has been documented in hyperten sive subjects [Mimraneta\., 1979;Prins, 1979], and in 1 case captopril induced renal failure [Hoorntje et al, 1982], It is noteworthy that our 5 patients suffered from severe bilateral (or unilateral in the case of a single kidney) renal vascular disease. This was also the case in at least 4 of the reported cases of captopril-induced renal failure Collste et al, 1979;Planz and Bundschu, 1980;Hoorntje et al, 1982], This high incidence suggests that patients with severe renal artery disease are prone to the development of captopril-induced renal fail ure. In these patients captopril should be used cautiously.…”

“…In several case reports [Collste et al, 1979;Gavras et al, 1978;Woodhouse et al, 1979;Planz and Bundschu, 1980] the impairment of renal function has been attributed to the captopril-induced fall in blood pressure and the attendant decrease in renal blood flow. Support for this hypothesis was provided by similar observations of renal failure follow ing the administration of vasodilating hypotensive drugs such as minoxidil [Collste et al, 1979] and nitroprusside [Planz and Bundschu, 1980].…”

Captopril-induced acute renal artery thrombosis and persistent anuria in a patient with documented pre-existing renal artery stenosis and renal failure

“…Its main activity is in inhibiting angiotensin-I-converting enzyme. Recent reports have indicated that the dramatic fall in blood pressure which may follow captopril therapy can cause reversible renal failure (Planz and Bundschu, 1980;Kawamura et aL, 1982). Reversible renal failure occurring without hypotension has been reported in three patients by Silas et aL (1983) all of whom were found to have renal artery stenosis affecting a single functioning kidney and in 11 patients by Hricik et aL (1983) with severe hypertension associated with either bilateral renal artery stenosis or renal artery stenosis in a single kidney.…”