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Converting enzyme inhibitors and renal function in essential and renovascular hypertension
A Mimran1, J Ribstein, G DuCailar
1Department of Medicine, Centre Hospitalier Universitaire, Montpellier, France.
Insights
Converting enzyme inhibitors (CEI) can cause acute kidney injury, especially in patients with renal artery stenosis. This reversible condition highlights the importance of careful patient selection and monitoring during hypertension treatment.
Area of Science:
- Nephrology
- Cardiovascular Medicine
- Pharmacology
Background:
- Converting enzyme inhibitors (CEI) are widely used for hypertension management.
- Angiotensin plays a critical role in regulating glomerular filtration rate (GFR).
- Acute renal deterioration can occur with CEI use in specific conditions like volume depletion or renal artery stenosis.
Purpose of the Study:
- To investigate the occurrence and characteristics of CEI-induced renal dysfunction.
- To assess the prevalence of renal artery stenosis in patients experiencing CEI-induced renal dysfunction.
- To evaluate the clinical implications for diagnosing renovascular hypertension.
Main Methods:
- A personal study was conducted on 28 patients with CEI-induced renal dysfunction.
- Patients' renal function was monitored during CEI treatment.
- Angiographic assessment was performed to detect renal artery abnormalities.
Main Results:
- CEI-induced renal dysfunction was reversible upon treatment discontinuation.
- Renal artery stenosis was identified in 61% of patients with CEI-induced renal dysfunction.
- 39% of patients had no significant renal artery abnormalities, indicating other contributing factors.
Conclusions:
- CEI-induced acute renal failure can occur without a drop in systemic blood pressure and is reversible.
- While not a definitive predictor, renal artery stenosis is common in these patients.
- Angiographic evaluation for renal artery stenosis may be warranted in select patients experiencing CEI-induced renal dysfunction.
Abstract:
Converting enzyme inhibitors (CEI) are useful in the treatment of hypertension. However, acute renal deterioration may occur in some conditions in association with the crucial role of angiotensin in the regulation of glomerular filtration rate (GFR), such as volume depletion, severe stenosis of both renal arteries, and stenosis of a single functioning kidney. CEI-induced acute renal failure can develop in the absence of a fall in systemic pressure, is facilitated by prior sodium depletion, and is reversible upon discontinuation of treatment. In a personal study conducted in 28 patients with CEI-induced renal dysfunction (reversible after discontinuation of CEI), the incidence of stenosis of large renal vessels was 61%, whereas 39% of these subjects had no significant renal artery abnormalities. Although the occurrence of such a complication is not a convincingly accurate predictor of the existence of renovascular hypertension, angiographic detection of renal artery stenosis (bilateral or on a single-functioning kidney) may be justified in some of these patients.