LONG-TERM FOLLOW-UP OF ACUTE-RENAL-FAILURE CAUSED BY ANGIOTENSIN-CONVERTING ENZYME-INHIBITORS

Angiotensin converting enzyme (ACE) inhibitors are useful in the treat ment of hypertension and heart failure. However, acute renal failure ( ARF) may occur in patients who are taking these drugs in situations as sociated with decreased glomerular filtration pressure, such as dehydr ation caused by acute diarrhea or diuretic therapy. Sixty-four patient s who were admitted to the intensive care unit for ARF associated with ACE inhibitor therapy were followed for more than 5 years. In this hi storical retrospective study, we documented that 45 patients were trea ted for hypertension (group I) and 19 were treated for heart failure ( group II). Their mean age was 71.2 +/- 11.6 years. Patients with ARF p resented with overt dehydration in 91% and 84% of the cases in groups I and II, respectively. Hypovolemia was caused by diuretics or gastroi ntestinal fluid loss. Bilateral artery-renal stenosis or stenosis in a solitary kidney was documented in 22% and 10% of patients in groups I and II, respectively. The probability of survival was 91% and 49% at 1 year and 64% and 18% at 5 years, for groups I and II, respectively. Acute renal failure required hemodialysis in seven patients, but none of them became dialysis dependent. In the subgroup of patients with pr eexisting chronic renal failure, all the patients except for one who b elonged to group II died within 2 years. In both groups, after resolut ion of ARF, plasma creatinine concentration returned to baseline level and the course of renal function was not significantly worsened. In c onclusion, ARF associated with ACE inhibitors is likely to occur in ma ny patients without renal artery stenosis after unexpected dehydration , especially in older patients with congestive heart failure. In both groups of patients, in the absence of preexisting chronic uremia, reco very of renal function occurred without sequelae, even after an episod e of acute tubular necrosis requiring dialysis. Am J Hypertens 1998; 1 1:1080-1086 (C) 1998 American Journal of Hypertension, Ltd.