title: The causal role of salt depletion in acute renal failure due to captopril in hypertensive patients with a single functioning kidney and renal artery stenosis.
abstract: Captopril (C) causes ARF in hypertensive patients with renal artery stenosis (RAS) with a single functioning kidney (SK). Retrospective studies in two patients showed that episodes of C-induced ARF were preceded by a rise in urinary Na+ excretion and a rapid decrease in body weight. These observations prompted us to investigate whether extracellular fluid volume depletion secondary to C-induced natriuresis can be responsible for ARF. Prospective studies were performed in four patients with RAS-SK treated with C. These studies have shown that: ARF is associated with negative Na+ balance and is corrected by salt replacement, even without interrupting C; ARF is preceded by a rise in urinary prostaglandin (PG) E2 and 6-keto-F1 alpha; ARF is prevented by either saline infusion or aspirin administration; ARF does not occur when the dose of C is not sufficient to raise PGs and urinary N + excretion. We conclude therefore that C-induced ARF in patients with RAS-SK can be secondary to salt depletion dependent on a raised secretion of PGs.
mesh_terms: D058186:Acute Kidney Injury / Q000139:chemically induced* / Q000652:urine; D000328:Adult; D000368:Aged; D002216:Captopril / Q000009:adverse effects*; D002648:Child; D004231:Diuresis / Q000187:drug effects; D005260:Female; D006801:Humans; D006978:Hypertension, Renovascular / Q000188:drug therapy* / Q000652:urine; D008297:Male; D008875:Middle Aged; D009318:Natriuresis / Q000187:drug effects*; D011446:Prospective Studies; D011453:Prostaglandins / Q000652:urine; D012083:Renin / Q000097:blood; D012189:Retrospective Studies; D012964:Sodium / Q000652:urine
chemical_list: D011453:Prostaglandins; D002216:Captopril; D012964:Sodium; D012083:Renin