Reversible renal insufficiency due to angiotensin converting enzyme inhibitors in hypertensive nephrosclerosis

Article Abstract:

Blood pressure-lowering medications in the category known as angiotensin converting enzymes, or ACE inhibitors, have been associated with kidney failure in certain patients. Affected patients are often found to have narrowing of the arteries leading to both kidneys or have only one functioning kidney whose artery is narrowed. Few other patients have been observed to have kidney abnormalities when treated with ACE inhibitors. A group of patients with high blood pressure that had already induced some degree of kidney damage, diagnosed as hypertensive nephrosclerosis, were assigned to various treatment groups with different blood pressure-lowering drugs, including enalapril, an ACE inhibitor. Eight of these patients (of a 42-member treatment group) were found to sustain reversible worsening of their kidney dysfunction, or reversible renal insufficiency, while taking enalapril. All eight patients were black and seven were male, and all had long-standing high blood pressure. These patients were observed to have experienced relative hypotension, or low blood pressure during the times that their kidney function worsened. Several of the patients were also receiving diuretics, or water pills, and several of the episodes of low blood pressure occurred during unusually hot weather spells, suggesting a role for dehydration in their low blood pressure. All eight underwent imaging studies to examine the arteries of their kidneys; none of the arteries were found to have any narrowing. When the patients' blood pressures were returned to their baseline levels, their kidney function also returned to baseline. Seven of the eight later tolerated a resumption of enalapril without further episodes of reversible renal insufficiency. The high number of cases of transient worsening of kidney function in these patients suggests that care must be exercised in prescribing enalapril to hypertensive patients with known kidney dysfunction, and that during conditions that might predispose these patients to dehydration, extra care should be taken that kidney function does not worsen. (Consumer Summary produced by Reliance Medical Information, Inc.)

Hypertension, Causes of, Complications and side effects, Acute renal failure, Acute kidney failure

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Outcome of renal crisis in systemic sclerosis: relation to availability of angiotensin converting enzyme (ACE) inhibitors

Article Abstract:

Systemic sclerosis is the hardening or induration of organs or tissues throughout the body, and may involve the kidneys. Scleroderma renal crisis is the most sudden and life-threatening symptom of systemic sclerosis and is commonly associated with malignant hypertension or high blood pressure, kidney failure, and early death. Angiotensin converting enzyme (ACE) inhibitors such as captopril are used to treat hypertension and were shown to improve the outcome from scleroderma renal crisis in some, but not all, patients. The outcome of renal crisis before and after the introduction of ACE inhibitors, and other factors associated with poor outcome were assessed in 108 patients, who developed scleroderma renal crisis between 1972 and 1987. Seventy-six percent of the patients treated with ACE inhibitors and 15 percent of untreated patients survived one year after scleroderma renal crisis. However, 24 of 55 patients treated with ACE inhibitors died early or required lifelong dialysis (the artificial filtration of the blood to remove toxic wastes). The most important factors that contributed to a poor outcome from this disease were older age and congestive heart failure (the inability of the heart to pump blood effectively, which leads to edema in the lungs). Twenty patients survived dialysis for more than three months and received ACE inhibitor treatment; eleven of these patients were able to discontinue dialysis after 3 to 15 months. By comparison, all 15 patients undergoing dialysis without ACE inhibitor treatment remained dependent on dialysis. These findings suggest that, in patients with scleroderma renal crisis, ACE inhibitors improve survival and allow dialysis to be discontinued. (Consumer Summary produced by Reliance Medical Information, Inc.)

Health aspects, Prognosis, Drug therapy

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