[Severe renal failure during treatment with angiotensin-converting enzyme inhibitors]

Three case histories are described which highlight some of the predisposing risk factors and therapeutic strategies in the event of acute severe renal failure during treatment with ACEI. With appropriate therapy, renal function is usually restored within a few days. Renal artery stenosis, dehydration and diuretics stimulate the renin angiotensin system and make preservation of normal renal function, increasingly dependent on angiotensin II. The prevalence of renal artery stenosis is substantially increased in patients with peripheral vascular disease or with coronary artery disease with concomitant hypertension. Patients should be told about the increased risk of adverse effects to the kidneys if they become dehydrated. In these cases it is essential to reduce the dose diuretics and ACEI, and it may be necessary to give parenteral fluid substitution.