[Acute and reversible interstitial granulomatous nephropathy after treatment with captopril]

Angiotensin-converting enzyme inhibitors (CEI) have been found effective in numerous cases of arterial hypertension, even non renovascular, and they are now widely used. However, the reference compound, captopril, has exhibited various side-effects, including acute renal failure. Different mechanisms may be responsible for this complication. In some case haemodynamic changes occur which are rapidly reversible after treatment is discontinued. In other, less frequent cases, captopril induces an immunoallergic interstitial nephritis, sometimes accompanied by skin rashes and/or eosinophilia. Since renal biopsies have been performed in only a few cases of CEI-induced nephropathy, we thought that it might be of interest to report a case of acute renal failure due to acute interstitial nephritis with epithelioid granulomas in the interstitium. The favourable outcome was confirmed by two successive follow-up renal biopsies.