title: Reversible renal insufficiency due to angiotensin converting enzyme inhibitors in hypertensive nephrosclerosis.
abstract: OBJECTIVE
  To review the incidence of reversible renal insufficiency in patients with hypertensive nephrosclerosis undergoing antihypertensive therapy.
  
  
  METHODS
  Retrospective analysis of 73 patients in a long-term blood pressure control study that compared the effects of an angiotensin converting enzyme (ACE) inhibitor plus conventional antihypertensive agents compared with placebo plus antihypertensive agents.
  
  
  METHODS
  Hospital-based outpatient treatment center.
  
  
  METHODS
  Patients were divided into group 1, which received enalapril plus conventional antihypertensives, and group 2, which received placebo plus conventional antihypertensives.
  
  
  METHODS
  Blood pressure and serum creatinine levels were measured, and imaging studies of the main renal arteries were done.
  
  
  RESULTS
  In group 1, eight of 42 patients (19%, 95% CI, 9% to 34%) developed reversible renal insufficiency, defined as an unexpected increase in serum creatinine of 88 mumol/L or higher. Six episodes of reversible renal insufficiency occurred during July and August when temperatures were 32.2 degrees C to 37.8 degrees C (90 degrees F to 100 degrees F). Renal artery stenosis was excluded by renal arteriogram or ultrasonic duplex scanning. All eight group-1 patients had a significant decrease in mean arterial pressure below their baseline level during reversible renal insufficiency (mean change, -28 +/- 10 mm Hg, P less than 0.001). The increase in the serum creatinine level was inversely correlated with the decrease in the mean arterial pressure (r = -0.68, P less than 0.01). Reversible renal insufficiency was successfully managed by withdrawing or reducing enalapril as well as other antihypertensive agents. Subsequently, enalapril was tolerated by seven of the eight patients without recurrence of renal insufficiency. In contrast, none of 31 (CI, 0% to 11%) patients in group 2 developed reversible renal insufficiency despite the fact that both the incidence of decreases in mean arterial pressure in 6 of 31 patients (19%) and the magnitude of the decreases in mean arterial pressure (mean change, -33 +/- 16 mm Hg) were similar to those observed in group 1.
  
  
  CONCLUSIONS
  Reversible renal insufficiency in hypertensive nephrosclerosis associated with ACE inhibitor therapy correlates with relative hypotension, is not dependent on renal artery stenosis, and can usually be managed by dose reduction.
authors.affiliation: University of Texas Southwestern Medical Center-Dallas.
authors.forename: R D
authors.initials: RD
authors.lastname: Toto
authors.forename: H C
authors.initials: HC
authors.lastname: Mitchell
authors.forename: H C
authors.initials: HC
authors.lastname: Lee
authors.forename: C
authors.initials: C
authors.lastname: Milam
authors.forename: W A
authors.initials: WA
authors.lastname: Pettinger
mesh_terms: D000368:Aged; D001794:Blood Pressure / Q000187:drug effects; D003404:Creatinine / Q000097:blood; D004311:Double-Blind Method; D004656:Enalapril / Q000009:adverse effects*; D005260:Female; D005919:Glomerular Filtration Rate / Q000187:drug effects; D006801:Humans; D006977:Hypertension, Renal / Q000188:drug therapy / Q000503:physiopathology*; D007674:Kidney Diseases / Q000097:blood / Q000139:chemically induced* / Q000503:physiopathology; D008297:Male; D008875:Middle Aged; D009400:Nephrosclerosis / Q000188:drug therapy / Q000503:physiopathology*; D011859:Radiography; D012077:Renal Artery / Q000000981:diagnostic imaging; D012189:Retrospective Studies; D014463:Ultrasonography
chemical_list: D004656:Enalapril; D003404:Creatinine