Gene/Protein Disease Symptom Drug Enzyme Compound
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Query: UMLS:C0035078 (renal failure)
 31,970 document(s) hit in 31,850,051 MEDLINE articles (0.00 seconds)

Angiotensin-converting enzyme (ACE) inhibitors have been available for about 10 years for the treatment of various forms of hypertension. Essential hypertension responds particularly well to the administration of this group of drugs, especially when combined with diuretics. A pronounced fall in blood pressure can be achieved in renovascular hypertension with high plasma renin levels; when ACE inhibitors were administered in diagnosed renal artery stenosis there was a significant rise in plasma renin activity on the affected side. Renoparenchymatous hypertension and hypertension in diabetes mellitus can also be improved by the long-term administration of ACE inhibitors, and the progression of renal failure in these disorders seems to be slowed down. Side effects such as neutropenia, exanthema, hearing disorders and pronounced hypotension with an acute deterioration in renal function are substance- and dose-dependent; regular monitoring of the patients greatly reduces their occurrence.
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PMID:Angiotensin-converting enzyme inhibition in renal and hypertensive disorders. 225 21

This is a report of a case history of a child with cerebral Moyamoya disease and gradual development of systemic hypertension. Sodium depletion combined with enalapril induced renal failure. A bilateral renal artery stenosis was found. Percutaneous transluminal angioplasty was not successful and was followed by autotransplantation of both kidneys. Histopathological examination of the renal arteries revealed intimal hyperplasia.
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PMID:Moyamoya disease associated with renovascular hypertension. 231 57

Eleven patients (five women and six men), aged 24-60 years, were treated with the angiotensin-converting enzyme (ACE) inhibitor, lisinopril, with a once-daily dose as the only antihypertensive treatment. Renal artery stenosis was unilateral in eight patients and bilateral in the remaining three. Fibromuscular dysplasia was present in seven patients, and renal arteriosclerotic narrowing was present in the remaining four. All completed a 6-month treatment and went on to a long-term treatment program for a final 24 months, now completed by five patients. Mean pretreatment blood pressure, 187 +/- 19/112 +/- 5 mm Hg (systolic/diastolic; mean +/- SD), was reduced to 148/87 following the drug titration period (1 week), and the same antihypertensive control was maintained throughout the study. Plasma concentration of angiotensin II, aldosterone, and serum ACE activity were effectively reduced for at least 24 h following drug administration. Serum concentrations of lisinopril varied individually and rose in two patients with moderate renal failure. Renal function was well maintained, and control renography revealed no worsening of renal artery stenosis or renal function. The drug was well tolerated without side effects other than cough in one patient. We conclude that lisinopril monotherapy is highly effective in renovascular hypertension. Drug safety was demonstrated by the lack of serious side effects.
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PMID:Long-term monotherapy with lisinopril in renovascular hypertension. 244 55

In elderly patients with generalized atherosclerosis and longstanding hypertension, progressive renal insufficiency should suggest renal artery occlusive disease and/or renal cholesterol embolization. Renal cholesterol embolization is not an absolute contraindication to successful surgical revascularization. Renal cholesterol emboli were identified in biopsy specimens obtained in 24 cases at the Cleveland Clinic from 1978 to 1986, and renal artery stenosis was an associated finding in 19. Clinical manifestations of generalized atherosclerosis were common, including ileofemoral atherosclerosis (18), coronary artery disease (16), carotid occlusive disease (15), and carotid occlusive disease with a history of stroke (8). Evidence of embolic events in other organs was common. Hypertension worsened before biopsy in 21 patients with and without renal artery stenosis. Surgery or angiography definitely or probably contributed to renal failure in 16. Of 12 who underwent surgical revascularization of a renal artery, renal function improved in five, remained stable in five, and worsened in one. Renal function improved in the three patients undergoing dialysis before revascularization, and two were able to discontinue dialysis.
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PMID:Atheroembolic renal disease: association with renal arterial stenosis. 252 69

The results of clinical studies indicate that percutaneous transluminal renal angioplasty (PTRA) is an effective means for treating renovascular hypertension resulting from renal artery stenosis. However, the indications for the patients with renal failure or renal atrophy are not established on a firm ground. We attempted PTRAs of ten kidneys in nine patients with hypertension associated with renal atrophy. They were followed for an average of 8 months by the methods including blood pressure, angiography or DSA, blood chemistry, and RI-renogram. We also evaluated enlargement of the renal size on an angiogram or on a plain film at DSA. Angiographic follow-up showed persistent relief of the stenosis in all cases. After PTRA, blood pressure reduced to normal or improved in two thirds of the patients for the follow-up period. In the study of three patients with excellent results for blood pressure, two patients showed the renal length to be increased by 1.0 cm or more, and one patient by 0.5 cm. In the same group, RI-renogram also showed good response. These data indicate that PTRA could improve total perfusion on the affected kidneys. On the other hand, in three patients with no change in blood pressure, there was poor response in both the renal size and the data of RI-renograms. We suggest that the irreversible changes might have occurred in these kidneys. It was difficult to predict cure group from no change group before PTRA.
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PMID:[Percutaneous transluminal renal angioplasty: indication for renovascular hypertension associated with renal atrophy]. 252 77

In approximately 10 p. 100 of the cases stenosis of the renal artery cannot be satisfactorily dilated by percutaneous transluminal angioplasty (PTA), and about 10 p. 100 of the patients successfully dilated have short-term restenosis. The excellent results obtained experimentally and clinically with the implantation of percutaneous intravascular stents have prompted us to use this material in the renal arteries. Stents were implanted in 10 patients who were followed up for periods of 1 to 16 months. Eight of them had restenosis after PTA; five of these stenoses were due to atheroma, 2 to fibromuscular dysplasia and 1 to Takayasu's disease. Two patients were implanted from the start owing to the insufficient results of PTA. Seven patients had severe arterial hypertension most probably of renovascular origin. Three patients had hypertension associated with moderate renal failure. Implantation was performed after a previous PTA. Adjuvant treatments and monitoring were the same in every case with, in particular, radiological control examination after one and six months. The implantations themselves were uneventful, and immediate control showed almost perfect anatomical restoration in all patients. On subsequent controls, arterial patency was preserved in all but one case. All patients showed significant clinical improvement. These results are most encouraging. They suggest that intravascular stents constitute an interesting solution when PTA is insufficient in the treatment of renal artery stenosis.
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PMID:[Usefulness of a percutaneous endoprosthesis in the treatment of renal artery stenoses]. 253 Sep 51

A case of irreversible renal failure during treatment with enalapril in bilateral renal artery stenosis is described. In the use of converting enzyme inhibitors, caution and monitoring of renal function during treatment is advised.
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PMID:[Irreversible renal failure during treatment with angiotensin I converting enzyme inhibitor in bilateral renal stenosis]. 255 56

Compelling arguments can be made for a local, intrarenal role as angiotensin's first action in phylogeny, with additional cardiovascular and endocrine responses arising later. Perhaps for that reason the vascular bed of the kidney is especially responsive to angiotensin II. Conversely, when the renin-angiotensin system is activated, as it is when sodium intake is restricted or diuretics are administered, the renal blood supply shows the most striking and consistent vasodilatation among vascular beds assessed after converting enzyme inhibition. When renal vascular tone is increased in patients with essential hypertension, converting enzyme inhibitors induce a potentiated acute renal vascular response: renal blood flow increases more than it does in normal subjects, with an associated consistent early increase in sodium excretion and an occasional increase in glomerular filtration rate. Reduced aldosterone release consequent on the block of angiotensin II formation also contributes to the natriuresis and results in positive potassium balance. With long-term therapy renal function tends to be well maintained. The response to converting enzyme inhibition in renal artery stenosis is more complex: as perfusion pressure distal to the stenosis falls there is typical afferent arteriolar dilatation and glomerular capillary pressure tends to be maintained by a rise in postglomerular resistance. To the extent that this is angiotensin mediated, suppression of angiotensin formation can reduce glomerular capillary pressure and thus filtration rate. This is well tolerated in the patient with unilateral stenosis and a healthy contralateral kidney, but can provoke renal failure where the stenosis is bilateral or involves a solitary kidney.(ABSTRACT TRUNCATED AT 250 WORDS)
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PMID:Angiotensin-converting enzyme inhibition: renal aspect. 258 Jan 75

Renal failure is progressive irrespective of the underlying primary renal disease or continued disease activity. Intrarenal haemodynamic changes may contribute to progressive loss of renal function, and may be modified by pharmacological therapies. Angiotensin-converting enzyme (ACE) inhibitors may have a specific therapeutic advantage in the treatment of hypertension associated with progressive renal disease. We have studied the effects of an ACE inhibitor and a calcium channel blocker on systemic BP, glomerular filtration, proteinuria and histological injury in animal models of progressive renal disease (the remnant kidney and diabetes). Systemic BP was lowered similarly by each treatment in both models. Beneficial effects on renal structure, proteinuria, and glomerular filtration only occurred in the ACE inhibitor-treated animals. Intrarenal haemodynamic effects of ACE inhibitors may therefore offer an advantage over other antihypertensive agents in progressive renal disease. Where there is reduced renal perfusion, intrarenal haemodynamic effects of ACE inhibitors may lead to compromised renal function. Acute renal failure is a common consequence of ACE inhibitor therapy in patients with bilateral renal artery stenosis, or renal artery stenosis to a single functioning kidney. Acute studies have suggested that these effects are reversible; function returns following withdrawal of ACE inhibitor therapy. We examined the long-term effects of ACE inhibitor therapy in rats with the two-kidney, one-clip (Goldblatt) model of hypertension. Rats were treated for 12 months with an ACE inhibitor or a vasodilator. After 1 year of treatment the clipped kidney from the ACE inhibitor-treated rats was small, fibrotic, and had no glomerular filtration. No functional improvement of the clipped kidney occurred following ACE inhibitor withdrawal.(ABSTRACT TRUNCATED AT 250 WORDS)
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PMID:Angiotensin-converting enzyme inhibition in renal disease; contrasting effects on renal function in renal artery stenosis and progressive renal injury. 267 36

In a 22 years old woman with recent hypertension, a timed intravenous pyelogram revealed an asymptomatic obstructive ureteropelvic junction. Preoperative renal vein catheterization demonstrated excessive renin release from the diseased kidney and low release from the other one, suggesting that corrective ureteral surgery should return blood pressure to normal levels. Moderately impaired glomerular filtration rate improved after surgery as a consequence of suppressed hydronephrosis and bilateral renal ischemia. Thus we conclude that in young people, asymptomatic unilateral hydronephrosis can lead to hypertension and renal failure like renal artery stenosis. In the other cases of urinary flow obstruction, secondary hypertension remains to be explained by both inappropriate production of renin and water chronic retention.
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PMID:[Arterial hypertension with renin hypersecretion secondary to pyelo-ureteral syndrome. Cure after corrective surgery]. 269 10


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