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)

Plasma renin activity (PRA) is markedly increased by captopril. There is not enough separation between the changes in PRA of patients with renal artery stenosis (RAS) to separate them reliably from those with essential hypertension. A minimal response may suggest primary aldosteronism. Captopril does increase the ratio of PRA in the venous blood from a kidney with RAS to that of the contralateral kidney. Captopril, 25 to 50 mg orally, given before renal vein PRA sampling will increase the sensitivity and specificity of the test. Treatment with current antihypertensive drugs need not be discontinued. Scleroderma renal crisis (SRC) used to be uniformly lethal within a few months. Modern, aggressive antihypertensive therapy has made survival of 2 or more years common. Not all patients respond, and some progress to renal failure despite good BP control. Captopril has been used with success in some patients with idiopathic edema. In conclusion, captopril markedly enhances the accuracy of renal vein renin assay for the diagnosis of RAS and is of major value in the treatment of SRC.
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PMID:Special uses for captopril. 288 46

We report on 5 patients with renal artery stenosis after renal transplantation. Renal arteriography showed the stenosis to be localized at the line of arterial anastomosis. The patients presented with refractory hypertension, with or without renal failure, 10 days to 13 months after transplantation. Percutaneous transluminal balloon angioplasty in 4 patients failed in 3 and produced temporary improvement in 1. Resection of the stenosis resulted in dramatic improvement of the clinical state in all 5 patients. Histological examination of the resected stenotic segment revealed a nodular fibrotic lesion at the anastomotic line in all cases, and was associated with extensive calcification in 3. Anastomotic line stenosis should be recognized as a specific entity causing transplant renal artery stenosis. The pathological changes observed explain the failure of transluminal angioplasty and suggest that surgical repair is the treatment of choice. Possible factors in the etiology of anastomotic line stenosis are discussed.
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PMID:Anastomotic line renal artery stenosis after transplantation. 294 Mar 75

Thirty-three patients with renal angiographic evidence of significant renal artery stenosis were referred for percutaneous transluminal angioplasty. The indications were poorly controlled hypertension (n = 13) or hypertension associated with deteriorating renal function (n = 20). Their mean age was 56 (23-73) years (12 males, 21 females). Causes of the renal artery stenosis were fibromuscular dysplasia (n = 8) and atheromatous changes (n = 25). Four patients were excluded, three due to technical failure. Forty-five angioplasties were performed in 29 patients with a mean observation period after angioplasty of 18 (one to 60) months. During this period eight patients (28 per cent) had a diastolic blood pressure of less than 90 mmHg without antihypertensive drugs, a further 15 patients (52 per cent) had improved blood pressure control with a significant reduction in the number and amount of antihypertensive drugs, but six patients (20 per cent) showed no improvement in blood pressure. Hypertension associated with the stenosis of fibromuscular dysplasia responded better to angioplasty than hypertension associated with atheromatous renal artery stenosis. Improvement in renal function was noted in eight patients with no change in 16 patients. Two patients with end-stage renal failure and atheromatous intrarenal vascular disease became dialysis dependent within four weeks of the procedure. One major and four minor complications occurred but there were no deaths related to angioplasty. Together with results from other centres this study indicates that percutaneous transluminal angioplasty should be considered the initial treatment choice for all patients with renovascular hypertension due to fibromuscular dysplasia and atheromatous renal artery stenosis.
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PMID:Percutaneous transluminal angioplasty improves blood pressure and renal function in renovascular hypertension. 295 95

A modified transluminal angioplasty technique for treatment of renal artery occlusion has been developed. From 1980 to 1985, 16 consecutive patients with 17 complete main renal artery occlusions underwent interventional transfemoral angiography for the purpose of recanalisation. In 12 patients the orifice of the renal artery could be clearly localised, so an attempt was made. Successful revascularisation of the occluded vessel was accomplished in seven patients. In four of these seven, contralateral renal artery stenosis was detected and dilated at the same session. Intact vasculature could be demonstrated distal to the occlusion. In six patients an improvement of renal function was apparent at the end of the dilatation procedure; this was indicated by the appearance of contrast material in the pelvicalyceal system. The mean serum creatinine fell from 4.6 +/- 2.9 to 1.9 +/- 0.4 mg/dl. Radioisotope studies confirmed improvement of renal function in the previously occluded kidney in four of four patients. Three patients had acute oliguric renal failure, which was reversible in two cases following revascularisation. Transluminal angioplasty improved hypertension in all cases. Mean blood pressure fell from 187/110 to 155/88 mmHg. Non-operative renal artery revascularisation can be achieved by transluminal angioplasty techniques and is an alternative to surgery in patients with increased operative risk.
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PMID:Non-operative revascularisation of renal artery occlusion by transluminal angioplasty. 297 98

Enalapril, an angiotensin converting enzyme (ACE) inhibitor, was given to 12 patients with renovascular hypertension: To five of them as a single drug after discontinuing other medications, and to seven patients as a substitute for one of their previous medications. The drug proved effective in controlling hypertension in all patients. Flushing and palpitations occurred in two of them, one of whom also showed a rise in creatinine and mild hyperkalemia. Two patients who had developed side effects while on captopril (renal deterioration in one, and severe rash in the other) tolerated enalapril well. Enalapril effectively reduced the blood pressure in the one patient with bilateral renal artery stenosis without causing renal failure.
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PMID:Enalapril in the treatment of renovascular hypertension. 300 Jun 54

Angiotensin-converting enzyme (ACE) inhibitors are a new class of drugs, whose main indications are the treatment of hypertension and of heart failure. Data obtained with captopril, the first orally active ACE inhibitor, affords an understanding of the rationale of their therapeutic use based on the knowledge of their mechanisms of action, efficacy, contraindications and precautions, dosage and frequency of administration, side-effects, interactions and advantages. ACE inhibitors appear to exert their haemodynamic effect mainly by inhibiting the renin-angiotensin-aldosterone system, but also by modulating sympathetic nervous system activity and by increasing prostaglandin synthesis. Therefore they act both on vasoconstrictor and volume factors, since they cause vasodilation (the main effect) and mild natriuresis without affecting the heart rate and contractility and, probably, favourably influencing renal, coronary and cerebral circulation. So far it appears that ACE inhibitors can be usefully employed in the treatment of heart failure, in which they reduce both pre- and after-load, and mainly of hypertension. In the past captopril has been used to treat only severe and or resistant hypertension and some secondary forms, like renal parenchymal and renovascular hypertension, but now it seems that captopril is useful also to treat mild to moderate essential hypertension. Their efficacy in reducing blood pressure is similar to that of thiazide diuretics and of beta-blockers, the two drugs now considered of first choice and they exert their hypotensive action without the development of pseudotolerance or tolerance. ACE inhibitors seem, at the moment, contraindicated in pregnancy and in hyperkalaemic syndromes and must be used with caution in patients with collagen disease (mainly associated with renal failure), with severe bilateral renal artery stenosis (and with severe artery stenosis of a solitary kidney) and with severe sodium depletion. It is now established that captopril has a flat dose response curve and that it must be given (twice daily) at a dose not exceeding 150 mg/day. The same pharmacological approach must be used with future ACE inhibitors in order to establish the right posology and the frequency of administration. In this respect enalapril seems to be a promising ACE inhibitor with a prolonged action (at least 24 hours). The exact posology of ACE inhibitors might be crucial, since it has been shown that the side-effects of captopril (skin rashes, fever, taste disturbances, proteinuria and neutropenia) are dose dependent.(ABSTRACT TRUNCATED AT 400 WORDS)
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PMID:Angiotensin-converting enzyme inhibitors in hypertension: a review. 300 82

We report 2 cases of severe hypertension and acute onset of anuria after renal transplantation in which angiography revealed renal artery stenosis. After renal artery reconstructive surgery renal function returned to normal and the hypertension improved. A high index of suspicion is needed to make the diagnosis. Only by heightened awareness of this important entity will patients with post-transplantation anuria secondary to renal artery stenosis be identified. Such patients may benefit from renal artery revascularization to reverse this type of renal failure.
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PMID:Post-transplant renal artery stenosis: a cause of anuria. Report of 2 cases corrected by revascularization. 304 43

Since their introduction in clinical practice in 1980, ACE inhibitors have been found useful in the treatment of hypertension and CHF. In hypertension, they are effective as monotherapy in 40% to 50% of the patients, and in combination with diuretics or calcium antagonists, they are effective in up to 85% of the patients. They are well tolerated, are not associated with depression, impotence, bronchospasm or metabolic derangements such as hypokalemia, hyperuricemia or hyperglycemia, and do not have adverse effects on the quality of life. As a result, they are preferred in hypertensive patients with CHF, left ventricular dysfunction, mental depression, older age, coronary artery disease, metabolic disorders, chronic destructive pulmonary disease, and peripheral vascular disease. In CHF they cause long-lasting hemodynamic and symptomatic improvement, improve exercise tolerance, and may lower mortality in certain patient subsets. Evolving new indications for ACE inhibitors include the diagnosis of renovascular hypertension, the prediction of surgical success, the treatment of scleroderma renal crisis, the reduction of proteinuria, renal protection, cardioprotection, the improvement of arterial compliance, in Bartter's syndrome and idiopathic edema, etc. ACE inhibitors are usually well tolerated but in some instances they may cause class-specific side effects such as hypotension; usually reversible azotemia or renal failure, especially in patients with renal artery stenosis or with CHF with low blood pressure; cough; angioedema; and hyperkalemia. Differences among ACE inhibitors are emerging and include chemical class (e.g., zinc ligand), biotransformation, potency, pharmacokinetics, prodrugs, tissue effects, additional pharmacologic properties, and drug interactions.
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PMID:Angiotensin converting enzyme inhibitors. II. Clinical use. 305 46

We present two patients with proved chronic glomerulonephritis who had severe refractory hypertension and chronic renal failure. In both patients normal-sized kidneys were demonstrated in addition to vascular bruits and Grade III hypertensive retinopathy. These findings raised the suspicion of an etiological condition other than chronic glomerulonephritis underlying the hypertension and renal failure. Renal angiography revealed bilateral severe renal artery stenosis. In both cases renal revascularization was followed by a drop in blood pressure to normal or near normal levels. In selected cases with severe hypertension and chronic renal failure, renal artery stenosis should be considered, despite the coexistence of chronic glomerulonephritis.
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PMID:Symptomatic renal artery stenosis superimposed on chronic glomerulonephritis. 315 24

Angiotensin converting enzyme (ACE) inhibitor-induced renal failure has been reported in bilateral renal artery stenosis and in stenosis in solitary kidneys, but not in unilateral renal artery stenosis. In these patients, however, a functional impairment of the kidney ipsilateral to the stenosis can often be detected after ACE inhibition by scintigraphic techniques employing glomerular radionuclide tracers like 99mTc-diethylenetriamine pentaacetic acid (DTPA). Dynamic renal scintigraphy with 99mTc-DTPA before and 1 hour after administration of captopril, 25 mg (renal scintigraphic captopril test; RSCT), was performed in a selected series of 39 hypertensive subjects with suspected renovascular hypertension. Changes in glomerular filtration rate induced by captopril on the individual kidney were estimated by assessing the early (120-180 seconds) DTPA uptake by the kidney. Values were expressed as the ratio between the kidney with the lower uptake and the contralateral one in 34 patients and as the ratio of the kidney counts to the injected dose in five patients with solitary kidneys, aortic coarctation, or both. Compared with precaptopril values, postcaptopril uptake decreased markedly in 14 subjects (-62.42 +/- 30.94 [SD]%; range, -25 to -100%) and decreased modestly or even increased in the other 25 (+0.57 +/- 9.83%; range, +28 to -13%). Of the 14 subjects considered to be RSCT-positive diagnostic workup revealed either established (10) or strongly suspected (2) renal artery stenosis in 12 and aortic coarctation in 2 subjects. In another patient with established renovascular hypertension, results of the RSCT were negative when performed in the supine position but became positive when repeated in the sitting position.(ABSTRACT TRUNCATED AT 250 WORDS)
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PMID:Renal scintigraphic captopril test in the diagnosis of renovascular hypertension. 330 67


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