Acute renal failure, skin rash, and eosinophilia associated with captopril therapy

A case of acute renal failure associated with captopril administration is reported. A woman, age 57, with a two-year history of hypertension presented with a generalized maculopapular rash preceded by pruritus after three weeks of captopril therapy. Her serum creatinine level on admission was 11.0 mg/dl. Renal biopsy was compatible with acute tubular necrosis without evidence of interstitial nephritis. A skin biopsy did not show any evidence of vasculitis. Captopril was discontinued, and her renal failure reversed over the course of nine days. A year later, the patient has good blood pressure control with stable renal function. Captopril has been associated with renal failure in patients with preexisting renovascular hypertension, and with acute interstitial nephritis in one case. The presentation of this case was similar to the latter case, but the renal biopsy did not show any evidence of acute interstitial nephritis.