A Reversible Syndrome of Acute Renal Failure Associated with Renin-Angiotensin Inhibitor Drugs

How to Cite:Mandal A. A Reversible Syndrome of Acute Renal Failure Associated with Renin-Angiotensin Inhibitor Drugs. Nephro-Urol Mon. 2010;2(4):. doi:

Abstract

Background and Aims: Previous studies indicate that angiotensin converting enzyme inhibitors (ACEI) cause acute renal failure (ARF) in patients with diabetes, hypertension, and congestive heart failure. Volume depletion is a determining factor for ACEI-induced ARF. This study presents a syndrome of reversible ARF accompanied by hyperkalemia, metabolic acidosis, and anemia associated with ACEI and angiotensin receptor blocker (ARB).

Methods: Data were collected from a total of 12 patients; 11 were admitted to the hospitals and 1 as an outpatient. Six patients had uncontrolled diabetes. Four of these patients also had hypertension. Eight patients (67 percent) received lisinopril; 4 (33 percent) received ARB. Diuretics were the commonest accompaniment. They showed moderate to severe azotemia. Estimated glomerular filtration rate (eGFR) ranged from 9.3 to 32.2 ml/min with an average eGFR of 14.1 ml/min. Six patients (50 percent) had moderate to severe hyperkalemia. All but 2 patients had metabolic acidosis, and 6 patients (50 percent) were anemic. ACEI or ARB and diuretics were discontinued in all patients, and all hospitalized patients were treated with normal saline or bicarbonate infusion, erythropoietin, and 9-alpha fluodrohydrocortisone, as required.

Results: Azotemia reversed and renal function improved to normal or near normal in 8 patients (67 percent). One of these patients required one-time hemodialysis. Renal function returned to baseline or better in 3 patients with preexisting renal insufficiency. Renal function improved in 1. All hyperkalemic patients became normokalemic, and all but 1 recovered from metabolic acidosis. Anemia also improved.

Conclusions: This novel observation substantiates our previous observation and further reiterates that ACEI/ARB causes a syndrome of reversible azotemia, hyperkalemia, metabolic acidosis, and anemia. Discontinuance of ACEI/ARB and diuretics-and treatment with a combination of bicarbonate infusion, 9-alpha fluodrohydrocortisone (Florinef®), and exogenous erythropoietin-hasten recovery from this syndrome. Continuation of a diuretic but without ACEI/ARB doesn't hinder renal function recovery.

Keywords

9-alpha Fluodrohydrocortisone

Erythropoietin

Full Text

Full text is available in PDF

Direct Renin Inhibitor: Aliskiren in Chronic Kidney Disease

Yoshiyuki Morishita,

Eiji Kusano

Morishita Y, Kusano E. Direct Renin Inhibitor: Aliskiren in Chronic Kidney Disease. Nephro-Urol Mon. 2012;5(1):668-672. doi: https://doi.org/10.5812/numonthly.3679

25

Sep

2023

A Closer Review of Therapeutic Effects of Renal Denervation on the Cardiorenal Syndrome: The Role of Classical and Non-Classical Renin-Angiotensin System Axes

Marzieh Maneshian,

Najmeh Kaffash Farkhad,

Sarieh Shahraki

Maneshian M, Kaffash Farkhad N, Shahraki S. A Closer Review of Therapeutic Effects of Renal Denervation on the Cardiorenal Syndrome: The Role of Classical and Non-Classical Renin-Angiotensin System Axes. J Clin Res Paramed Sci. 2023;12(2):e139751. doi: https://doi.org/10.5812/jcrps-139751

31

Jan

2010

Albuminuria Predicts Kidney Function Outcome in Egyptian Essential Hypertensive Patients

Osama El Minshawy,

Ashraf Osman

Minshawy O, Osman A. Albuminuria Predicts Kidney Function Outcome in Egyptian Essential Hypertensive Patients. Nephro-Urol Mon. 2010;2(1):. doi:

1

Mar

2017

Worsening Renal Function in Acute Decompensated Systolic Heart Failure; Observations from RASHF Registry, an Iranian Heart Failure Registry

Mohammad Hossein Soltani,

Mohammad Javad Alemzadeh-Ansari,

Sepideh Taghavi,

Behshid Ghadrdoost,

Majid Maleki,

Ahmad Amin

,et al.

Soltani MH, Alemzadeh-Ansari MJ, Taghavi S, Ghadrdoost B, Maleki M, et al. Worsening Renal Function in Acute Decompensated Systolic Heart Failure; Observations from RASHF Registry, an Iranian Heart Failure Registry. Int Cardiovasc Res J. 2017;11(1):e10547. doi:

19

Dec

2006

Acute Renal Failure in a Child with Idiopathic Nephritic Syndrome (A Case Study)

AA Niki Bakhsh,

H Mahmoudzadeh,

M Karamiyar,

B Ilkhanizadeh

Niki Bakhsh A, Mahmoudzadeh H, Karamiyar M, Ilkhanizadeh B. Acute Renal Failure in a Child with Idiopathic Nephritic Syndrome (A Case Study). J Kermanshah Univ Med Sci. 2006;10(3):e81818. doi:

Import into EndNote Import into BibTex

Share on

Comments

Number of Comments:0

Cited by

Scopus by DOI: 0
Last Update: 2 weeks ago
Scopus by Title: 0
Last Update: 2 weeks ago
Scopus by Title (Ref): 0
Last Update: 2 weeks ago
CrossRef: 0
Last Update: 1 day ago

Metrics

Ordering Reprints

Articles are published under the Creative Commons license stated on each article. No permission or royalty fee is required for uses permitted by that license. CCC handles optional bulk and customized reprint orders. Any quotation covers production and delivery services only, not copyright permission. > Request Reprints from CCC

Search Relations

Author(s):

Anil Mandal:[PubMed][Scholar]

Outlines

A Reversible Syndrome of Acute Renal Failure Associated with Renin-Angiotensin Inhibitor Drugs

Abstract

Full Text

Similar Articles

Direct Renin Inhibitor: Aliskiren in Chronic Kidney Disease

A Closer Review of Therapeutic Effects of Renal Denervation on the Cardiorenal Syndrome: The Role of Classical and Non-Classical Renin-Angiotensin System Axes

Albuminuria Predicts Kidney Function Outcome in Egyptian Essential Hypertensive Patients

Worsening Renal Function in Acute Decompensated Systolic Heart Failure; Observations from RASHF Registry, an Iranian Heart Failure Registry

Acute Renal Failure in a Child with Idiopathic Nephritic Syndrome (A Case Study)

Last Update: 2 weeks ago

Last Update: 2 weeks ago

Last Update: 2 weeks ago

Last Update: 1 day ago