ACUTE-RENAL-FAILURE RELATED TO NONSTEROID AL ANTIINFLAMMATORY DRUGS AND ANGIOTENSIN-CONVERTING ENZYME-INHIBITORS

In order to evaluate the frequency, risk factors, course and complicat ions of acute renal failure caused by nonsteroidal anti-inflammatory d rugs (NSAIDs) and angiotensin-converting enzyme (ACE) inhibitors, we h ave reviewed 144 cases of non obstructive acute renal failure admitted to our Unit between January 1985 and October 1996. Renal transplant r ecipients were excluded. Treatment with NSAIDs or ACE inhibitors was i mplicated in 48 cases (33,3%), 21 male and 27 female, with a mean age of 68 +/- 12.7 years. The duration of previous treatment with these dr ugs conformed a bimodal distribution with one maximum at 7 days and an other at 5 years. The most frequent presentation (37%) was silent decl ine in renal function. Predisposng factors like dehydration, hypotensi on and diuretics were identified in 98% of the cases. Of considerable importance was the presence of previous renal dysfunction (serum creat inine > 2 mg/dl) which was found in 52% of the patients. Hyperkalemia (> 6.5 mEq/L) was detected in 25% of the cases and renal replacement t herapy with dialysis was required in 29%. There were no deaths and 63% of the patients recovered renal function completely. Contrast angiogr aphy was performed in 9 of the patients treated with ACE inhibitors an d significant stenosis (> 50% reduction of the vascular lumen) was det ected in 6 of them. In conclusion, the risk of acute renal failure mus t be taken into account in elderly patients with micro or macrovascula r renal lesions when therapy with NSAIDs or ACE inhibitors in establis hed, particularly if associated with hypovolemia, diuretic treatment o r previous renal function impairment. It is advisable to chek renal fu nction and kalemia at the beginning and at least during the first week s of treatment.