[Acute renal failure, renal artery stenosis and angiotensin-converting enzyme (ACE) inhibitor].
BACKGROUND
Acute renal failure is a well-known complication in patients with renal artery stenosis during treatment with ACE inhibitor. Renal artery thrombosis after withdrawal of ACE inhibitor has not been reported previously.


METHODS
We describe a patient with acute renal failure with an unexpected course.


RESULTS
A 67-year-old man was admitted with acute anuric renal failure during treatment with hydrochlorothiazide and enalapril. His blood pressure was 165/60 mm Hg. Renal ultrasound was normal. After initial rehydration and dialysis, diuresis resumed until a sudden unexpected anuric renal failure recurred on day 12. Angiography disclosed bilateral renal artery occlusion. The right renal artery was successfully opened and a stenosis was blocked and stented, and brisk diuresis ensued. Two days later hypertension accelerated, and a new invasive procedure on day 24 succeeded in opening, blocking and stenting a proximal stenosis in the left artery; a mobile thrombus was located behind the stenosis and successfully treated with intraarterial thrombolysis. Blood pressure rapidly normalized, and serum creatinine was normal on visits 1.5 and 4 months later.


CONCLUSIONS
General aspects and prevention of acute renal failure during ACE inhibitor therapy are discussed. Acute renal thrombosis after withdrawal of ACE inhibitor in patients with stimulated renin angiotensin system and significant renal artery stenosis may be causally related to the antifibrinolytic effects of angiotensin II and aldosterone. Endovascular reconstruction of renal artery occlusion may completely restore the kidney function.
Svarstad
E
E
Nyreseksjonen Medisinsk avdeling, Haukeland Sykehus 5021 Bergen. einar.svarstad@haukeland.no
Hultstrøm
D
D
Jensen
D
D
Jenssen
G
G
Gravendeel
J
J
Iversen
B M
BM
D058186:Acute Kidney Injury / Q000139:chemically induced* / Q000628:therapy; D000368:Aged; D000806:Angiotensin-Converting Enzyme Inhibitors / Q000008:administration & dosage / Q000009:adverse effects*; D000959:Antihypertensive Agents / Q000008:administration & dosage / Q000009:adverse effects*; D004232:Diuretics; D004656:Enalapril / Q000008:administration & dosage / Q000009:adverse effects*; D006801:Humans; D006852:Hydrochlorothiazide / Q000008:administration & dosage; D008297:Male; D011859:Radiography; D012078:Renal Artery Obstruction / Q000139:chemically induced* / Q000000981:diagnostic imaging / Q000601:surgery; D012084:Renin-Angiotensin System / Q000187:drug effects; D049993:Sodium Chloride Symporter Inhibitors / Q000008:administration & dosage
D000806:Angiotensin-Converting Enzyme Inhibitors; D000959:Antihypertensive Agents; D004232:Diuretics; D049993:Sodium Chloride Symporter Inhibitors; D006852:Hydrochlorothiazide; D004656:Enalapril