Related Experiment Videos
Initial effect of enalapril on kidney function in patients with moderate to severe chronic nephropathy
A L Kamper1, H S Thomsen, S L Nielsen
1Department of Nephrology, Herlev Hospital University of Copenhagen, Denmark.
Abstract:
Angiotensin converting enzyme (ACE) inhibitors has been suggested to halt the progression of chronic renal failure. As the initial step of a controlled trial of this hypothesis, it was investigated whether start of enalapril in patients with severe chronic nephropathy might cause a critical fall in their renal function. Thirty-one patients were studied, 26 on chronic antihypertensive treatment with drugs other than ACE inhibitors and 5 untreated normotensive. 51Cr-EDTA plasma clearance and renal technetium-99m dimercaptosuccinic acid (99mTc-DMSA) scintigraphy were made before and 24 h after start of enalapril, mean dose 9 mg. Blood pressure fell from median 148/88 to 119/78 mmHg (p less than 0.01). Glomerular filtration rate (GFR) fell from median 14 to 12 ml/min/1.73 m2 (p less than 0.01). The median change in GFR was -14% (range -44% to +10%). The split renal function was unchanged and the scintigrams showed no intrarenal activity defects. In conclusion, enalapril caused a fall in GFR, which was clinically acceptable in most of the patients.
Insights
Enalapril, an angiotensin converting enzyme (ACE) inhibitor, caused a modest decrease in glomerular filtration rate (GFR) in patients with severe nephropathy. This decline in renal function was generally well-tolerated, suggesting potential safety for ACE inhibitors in managing kidney disease.
Area of Science:
- Nephrology
- Pharmacology
- Cardiovascular Medicine
Background:
- Angiotensin converting enzyme (ACE) inhibitors are hypothesized to slow chronic renal failure progression.
- Investigating the immediate renal effects of initiating enalapril in severe nephropathy is crucial.
Purpose of the Study:
- To assess the impact of initiating enalapril on renal function in patients with severe chronic nephropathy.
- To determine if enalapril causes a critical decline in glomerular filtration rate (GFR).
Main Methods:
- 31 patients with severe chronic nephropathy were studied.
- Renal function assessed via 51Cr-EDTA plasma clearance and 99mTc-DMSA scintigraphy before and 24h after a mean 9mg enalapril dose.
- Patients included those on other antihypertensives and untreated normotensives.
Main Results:
- Blood pressure significantly decreased from 148/88 to 119/78 mmHg (p<0.01).
- Glomerular filtration rate (GFR) decreased from a median of 14 to 12 ml/min/1.73 m2 (p<0.01), a median change of -14%.
- Split renal function and scintigraphy showed no intrarenal defects.
Conclusions:
- Enalapril initiation leads to a clinically acceptable fall in GFR in most patients with severe nephropathy.
- The findings support further controlled trials on ACE inhibitors for chronic renal failure.
- Immediate renal function changes with enalapril are generally not critical.