Haemodynamic, renal and hormonal responses to enalkiren in four patients with post-surgical oliguria.
1. The haemodynamic and hormonal responses of four patients with acute post-surgical oliguria (urine output < 0.5 mL/kg per h) were measured in response to the renin inhibitor enalkiren. Enalkiren was infused at 0.01 up to 0.1 mg/kg per h for up to 4 h. 2. Enalkiren infusion was associated with a progressive fall in blood pressure, clinically significant in three of the four patients. Systemic vascular resistance fell in proportion to blood pressure fall. Cardiac output and pulse rate remained unchanged. Effective renal plasma flow rose in all four cases (236 +/- 19 to 327 +/- 38). There was no change in urine flow rate, or urinary sodium excretion. 3. Plasma renin activity (ng angiotensin I/mL per h) fell from 1.9 +/- 0.5 to 0.02 +/- 0.01 (P < 0.04), plasma angiotensin II (pg/mL) fell from 104 +/- 93 to 7.7 +/- 1.5, and plasma aldosterone (ng/dL) fell from 32 +/- 8 to 21 +/- 9 (P = 0.03) at the highest infusion dose. 4. Enalkiren inhibited plasma renin activity with reduced plasma angiotensin II and aldosterone concentrations. This was associated with vasodilation, reduced blood pressure and maintained cardiac output. There was no beneficial effect on renal function in these patients with post-surgical oliguria.
University of Melbourne, Department of Medicine Austin Hospital, Heidelberg, Victoria, Australia.
B
B
Jackson
G
G
Liu
R B
RB
Perich
D
D
Paxton
L
L
McNicols
G
G
Gutteridge
C I
CI
Johnston
D000450:Aldosterone / Q000097:blood; D000804:Angiotensin II / Q000097:blood; D001794:Blood Pressure / Q000187:drug effects; D002302:Cardiac Output / Q000187:drug effects; D001026:Coronary Artery Bypass; D004151:Dipeptides / Q000008:administration & dosage / Q000009:adverse effects / Q000627:therapeutic use*; D006439:Hemodynamics / Q000187:drug effects*; D006728:Hormones / Q000097:blood*; D006801:Humans; D007668:Kidney / Q000187:drug effects*; D009846:Oliguria / Q000188:drug therapy* / Q000503:physiopathology; D011183:Postoperative Complications / Q000188:drug therapy* / Q000503:physiopathology; D011674:Pulse / Q000187:drug effects; D017596:Renal Plasma Flow, Effective / Q000187:drug effects; D012083:Renin / Q000097:blood; D012084:Renin-Angiotensin System / Q000187:drug effects; D014655:Vascular Resistance / Q000187:drug effects; D000092502:Renin Inhibitors
D000450:Aldosterone; D000804:Angiotensin II; D004151:Dipeptides; D006728:Hormones; D012083:Renin; D000092502:Renin Inhibitors; C056622:enalkiren