title: Enalapril Associated with Furosemide Induced Acute Kidney Injury in an Infant with Heart Failure. A Case Report, a Revision of the Literature and a Pharmacovigilance Database Analysis.
abstract: The use of angiotensin converting enzyme (ACE) inhibitors in combination with diuretics is a common strategy used for the treatment of patients affected by heart failure. An infant affected by initial congestive cardiac failure, after starting the treatment with enalapril in association with furosemide, developed acute kidney injury (AKI). No underlying renal disease or renal artery stenosis was found. He recovered from kidney injury after the therapy was suspended, thus suggesting that the drug combination is responsible for the onset of the adverse reaction. The present case report, the appraisal of the current knowledge on the onset of AKI and the analysis of available pharmacovigilance databases indicate that particular caution should be exercised when infants affected by heart failure are treated with the enalapril and furosemide combination therapy. Moreover, we strongly suggest an up-to-date revision of the ACE-inhibitor dosing guidelines in pediatric patients to define unambiguously the safe upper limits of this class of drugs.
authors.affiliation: Université degli Studi di Milano, Department of Pediatrics, Children's Hospital V. Buzzi, Milan, Italy.
authors.forename: Valentina
authors.initials: V
authors.lastname: Fabiano
authors.forename: Carla
authors.initials: C
authors.lastname: Carnovale
authors.forename: Marta
authors.initials: M
authors.lastname: Gentili
authors.forename: Sonia
authors.initials: S
authors.lastname: Radice
authors.forename: Gian Vincenzo
authors.initials: GV
authors.lastname: Zuccotti
authors.forename: Emilio
authors.initials: E
authors.lastname: Clementi
authors.forename: Cristiana
authors.initials: C
authors.lastname: Perrotta
authors.forename: Chiara
authors.initials: C
authors.lastname: Mameli
mesh_terms: D058186:Acute Kidney Injury / Q000139:chemically induced*; D000806:Angiotensin-Converting Enzyme Inhibitors / Q000009:adverse effects* / Q000627:therapeutic use; D004232:Diuretics / Q000009:adverse effects* / Q000627:therapeutic use; D004347:Drug Interactions; D004359:Drug Therapy, Combination; D004656:Enalapril / Q000009:adverse effects* / Q000627:therapeutic use; D005665:Furosemide / Q000009:adverse effects* / Q000627:therapeutic use; D006333:Heart Failure / Q000188:drug therapy* / Q000209:etiology; D006345:Heart Septal Defects, Ventricular / Q000150:complications; D006801:Humans; D007223:Infant; D008297:Male
chemical_list: D000806:Angiotensin-Converting Enzyme Inhibitors; D004232:Diuretics; D004656:Enalapril; D005665:Furosemide