Severe side-effects of captopril in advanced chronic kidney insufficiency

Using equal or lower than manufacturer's recommended doses of Captopril in 10 hypertensive patients with creatinine clearance less than 30 ml/min severe side-effects were observed in four cases. The adverse reactions continued after stopping the drug. One case developed symptomatic thrombocytopenia; one other, a lethal infected exfoliative dermatitis and an irreversible deterioration of her renal function. The other two cases demonstrated severe aggravation of their CRF, one requiring dialysis. The protective effect of dialysis against these side-effects is obvious in this series and dialysis may also accelerate the resolution of the complications. Suggestions for the management of this kind of patient with Captopril are made.