title: Captopril induced reversible acute renal failure in a premature neonate with double outlet right ventricle and congestive heart failure.
abstract: BACKGROUND
  captopril is well tolerated in most patients. There is no report of acute deterioration in renal function after administration of captopril in neonates with congestive heart failure secondary to congenital heart defects with large left-to-right shunts.
  
  
  METHODS
  we report a premature neonate with double outlet right ventricle and congestive heart failure who developed acute renal failure after administration of captopril at a low dose of 0.1 mg/kg per 8 hours.
  
  
  RESULTS
  on the third day after captopril therapy, the levels of serum creatinine and blood urea nitrogen increased to 2.6 mg/dl and 73 mg/dl respectively, and hyperkalemia appeared. Captopril was discontinued immediately. On the fourth day, the infant developed oliguria which persisted for 24 hours and resolved on the fifth day when the serum potassium normalized to 4.5 mmol/L. The level of serum creatinine peaked at 3.9 mg/dL on the sixth day and gradually decreased to normal on the ninth day after administration of captopril. The captopril-induced acute renal failure resolved completely after cessation of the drug.
  
  
  CONCLUSIONS
  attention should be given to captopril therapy in premature neonates with congestive heart failure secondary to congenital heart disease with large left-to-right shunts. Routine hemodynamic examination and biochemical monitoring are suggested before and during captopril therapy.
authors.affiliation: Department of Surgical Intensive Care Unit, Children's Hospital, Zhejiang University School of Medicine, Hangzhou, Zhejiang 310003, China.
authors.forename: Lin-Hua
authors.initials: LH
authors.lastname: Tan
authors.forename: Li-Zhong
authors.initials: LZ
authors.lastname: Du
authors.forename: Michael R
authors.initials: MR
authors.lastname: Carr
authors.forename: Julia K
authors.initials: JK
authors.lastname: Kuzin
authors.forename: Brady S
authors.initials: BS
authors.lastname: Moffett
authors.forename: Anthony C
authors.initials: AC
authors.lastname: Chang
mesh_terms: D058186:Acute Kidney Injury / Q000139:chemically induced*; D000806:Angiotensin-Converting Enzyme Inhibitors / Q000008:administration & dosage / Q000009:adverse effects*; D002216:Captopril / Q000008:administration & dosage / Q000009:adverse effects*; D004310:Double Outlet Right Ventricle / Q000150:complications / Q000188:drug therapy*; D006333:Heart Failure / Q000188:drug therapy* / Q000209:etiology; D006439:Hemodynamics; D006801:Humans; D007231:Infant, Newborn; D007234:Infant, Premature; D008991:Monitoring, Physiologic
chemical_list: D000806:Angiotensin-Converting Enzyme Inhibitors; D002216:Captopril