title: Aliskiren-associated acute kidney injury in a patient with pre-existing chronic kidney disease and dilated cardiomyopathy.
abstract: We report a case of acute kidney injury (AKI) caused by a novel direct renin inhibitor, aliskiren. A 43-year-old Japanese man with dilated cardiomyopathy on cardiac resynchronization therapy with defibrillator and chronic kidney disease (CKD) was started on aliskiren in addition to enalapril, carvedilol, furosemide, and spironolactone for worsening cardiac function suggested by the elevation of serum brain natriuretic peptide. After 1 month, he noticed general malaise, loss of appetite and his serum creatinine level increased from 2.0 to 7.24 mg/dL. He had no evidence of exacerbation of hemodynamic instability (heart failure or hypotension) or post-renal cause of AKI. Although a cessation of aliskiren did not ameliorate AKI, renal function returned to baseline after withholding enalapril. Careful monitoring is necessary when aliskiren is used in patients with CKD and/or significant systolic dysfunction since it can cause normotensive ischemic AKI, especially when there is a concomitant use of other renin-angiotensin-aldosterone system inhibitors.
authors: Department of Nephrology and Hypertension, St. Marianna University Hospital, 2-16-1 Sugao, Miyamae, Kawasaki, Kanagawa, 216-8511, Japan. yamauchizz-ycu@umin.ac.jp
authors: Junji
authors: J
authors: Yamauchi
authors: Yugo
authors: Y
authors: Shibagaki
authors: Keita
authors: K
authors: Uehara
authors: Takashi
authors: T
authors: Yasuda
authors: Kenjiro
authors: K
authors: Kimura
mesh_terms: D058186:Acute Kidney Injury / Q000139:chemically induced*; D000328:Adult; D000577:Amides / Q000009:adverse effects*; D000959:Antihypertensive Agents / Q000009:adverse effects*; D002311:Cardiomyopathy, Dilated / Q000150:complications / Q000188:drug therapy*; D005650:Fumarates / Q000009:adverse effects*; D006801:Humans; D007676:Kidney Failure, Chronic / Q000150:complications / Q000188:drug therapy*; D008297:Male; D020097:Natriuretic Peptide, Brain / Q000097:blood
chemical_list: D000577:Amides; D000959:Antihypertensive Agents; D005650:Fumarates; D020097:Natriuretic Peptide, Brain; C446481:aliskiren