[Non-steroidal anti-inflammatory agent and angiotensin converting enzyme inhibitor: a dangerous combination during...

A 72-year-old man experienced a postoperative acute renal failure (ARF) from a nonsteroidal anti-inflammatory drug (NSAID) and an angiotensin converting enzyme inhibitor (ACEI) intake and promoted by an unrecognized myeloma, peroperative hypotension and hormonal response to surgical stress. This drug combination can result in ARF through a fall of glomerular filtration by combined renal blood flow changes: NSAID inhibit vasodilation by renal prostaglandins, and the vasoconstrictor effect on the efferent arteriole is inhibited by the ACEI. Nephrotoxicity during the simultaneous use of ACEI and NSAID is increased by other risk factors of renal insufficiency such as ageing, preexisting renal disease and hypovolaemia. In these cases, a preventive therapy should be considered.