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)

Converting enzyme inhibitors (CEI) are efficient antihypertensive medications. The acute and chronic effects of captopril (SQ) on renal function and electrolyte balance are analyzed in the present paper. Acute administration of SQ was associated with renal vasodilatation in the patients with essential hypertension (EH) but had no effect in normal subjects with similar renin levels thus suggesting an enhanced renal vascular response to CEI in EH. A variable effect of CEI on renal function was observed in renovascular hypertension; GFR fell when blood pressure decreased by more than 25 mmHg. Three cases of striking recovery of GFR during chronic SQ in young patients with malignant nephrosclerosis maintained on hemodialysis are reported. Such an improvement in GFR never occurred in patients with primary renal disease. When systemic and renal responses to acute isotonic saline loading were assessed, captopril blunted the exaggerated natriuretic response to saline loading observed in EH and unmasked the volume-dependence of arterial pressure. A case of hyperkalemia during treatment with SQ is reported in a patient with bilateral renal artery stenosis who developed moderate renal failure during treatment. This was associated with high plasma aldosterone whilst fractional excretion of K+ was inappropriately low for the level of serum creatinine thus suggesting that tubular unresponsiveness to aldosterone may have developed during SQ.
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PMID:Renal aspects of treatment by converting enzyme inhibitors in hypertension. 631 75

Among vascular beds, that of the kidney is especially responsive to angiotensin II, perhaps a reflection of the fact that the renin-angiotensin axis is normally a volume-control rather than a pressure-control system. The dose of angiotensin required to induce renal vasoconstriction in a normal subject receiving a typical, liberal sodium intake, for example, is about an order of magnitude lower than that required to induce a pressor response. Indeed, 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. In patients with essential hypertension, in whom renal vascular tone is commonly increased, converting enzyme inhibitors such as teprotide and captopril induce a potentiated acute renal vascular response: renal blood flow increases more than it does in normal subjects. The result is a consistent, early increase in sodium excretion and an occasional increase in glomerular filtration rate. Reduced aldosterone release consequent to 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 very well maintained. In renal artery stenosis the situation is more complex: as perfusion pressure distal to the stenosis falls, typically afferent arteriolar dilatation exists and glomerular capillary pressure tends to be maintained by an increase in postglomerular resistance. To the extent that this increase is angiotensin-mediated, suppression of angiotensin formation with captopril 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 when the stenosis is bilateral or involves a solitary kidney. The available evidence suggests that the converting enzyme inhibitor's influence on the kidney primarily reflects reduced angiotensin II formation, although reduced kinin degradation or increased prostaglandin synthesis may also have an influence. Whatever the mechanism responsible for the renal response, there are compelling reasons for suspecting that the salutary action of captopril on the kidney makes a substantial contribution to its over-all efficacy in the treatment of hypertension.
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PMID:Renal hemodynamics in essential and renovascular hypertension. Influence of captopril. 632 83

A living related kidney transplant recipient with normal renal function and severe hypertension secondary to renal artery stenosis, was treated with captopril and developed reversible renal failure requiring temporary hemodialysis. This complication of captopril, an angiotensin converting enzyme inhibitor, has been reported previously in hypertensive patients with renal artery stenosis with and without a kidney transplant. It is recommended that this drug be used with caution in this setting.
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PMID:Captopril-induced acute renal failure in a kidney transplant recipient. 634 92

The efficacy and safety of captopril were studied in 10 patients with secondary hypertension (renal parenchymal disease, four patients; renal artery stenosis, two; and renal transplant rejection, four). Captopril was administered according to a dose titration protocol that randomized the initial three doses (0.5, 1.0, and 2.0 mg/kg) of drug to one of six possible sequences. All patients received diuretics prior to and during captopril therapy. A significant reduction in mean blood pressure was observed in all 10 patients during the initial dose titration. No correlation was observed between captopril dose and magnitude of the blood pressure reduction. The onset of antihypertensive action began approximately 15 minutes after each orally administered dose and reached the nadir approximately 1 1/2 hours later. Blood pressure returned to predrug levels between 6 and 10 hours after the dose. A significant reduction in systolic and diastolic blood pressure was noted in all subjects after 1 week of captopril treatment and was maintained during the course of continuous therapy in nine of 10 patients. Captopril combined with hydrochlorothiazide produced a satisfactory therapeutic response in five patients; in four others, additional antihypertensive drugs were required. No significant adverse effects were observed. Plasma renin activity determined prior to initiation of captopril was not predictive of blood pressure response to the drug. The clearance of captopril from patients with kidney failure ranged from 14.1 to 18.8 ml/min/kg in five subjects with creatine clearance between 10 and 21 ml/min/1.73 m2.
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PMID:Antihypertensive effect and elimination kinetics of captopril in hypertensive children with renal disease. 635 21

Conventional arteriography in patients with kidney transplants and severe hypertension is performed principally to determine the presence of a renal artery stenosis. In patients with renal failure its use enables detection of any arterial lesions. Technological advantages provided by computerized angiography within the field of medical imaging should permit earlier diagnosis of arterial lesions, with a reduced risk and at a lower cost using a simple intravenous injection of the iodized contrast medium.
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PMID:[Intravenous subtraction angiography in kidney transplant patients]. 636 84

A 26-year-old female diabetic patient developed hypertensive encephalopathy with gross neurological abnormalities complicating renal artery stenosis of her transplant kidney. The elevated blood pressure was unresponsive to medical treatment. Surgical correction of the stenoses in the renal artery cured the hypertension and renal failure and led to the patient's complete recovery.
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PMID:Hypertensive encephalopathy complicating transplant renal artery stenosis. 637 86

We describe an elderly man, with pre-existing renal failure and atheromatous renal artery stenosis, who developed persistent anuria due to renal artery thrombosis after acute hypotension following captopril administration. Caution should be used when captopril is first administered to patients with impaired renal function in whom renal artery stenosis is known or suspected.
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PMID:Captopril-induced acute renal artery thrombosis and persistent anuria in a patient with documented pre-existing renal artery stenosis and renal failure. 638 25

52 children with renal allograft received captopril during 56 periods of treatment. High blood pressure (BP) was due to renal artery stenosis in 22 patients, to diffuse vascular lesions (mainly due to chronic rejection) in 13, to high-dose corticosteroid treatment in the early phase in 11, and to various or unknown causes in 10 patients. In the last 3 groups (including 34 cases) captopril use did not induce any marked drawback. In the absence of overload, a good control of BP was obtained with a mean dosage of 2.2 mg/kg (0.7----5 mg/kg). A mild, transient renal failure (RF) was observed in 6 patients, who were given diuretics without any need. The 22 patients with renal artery stenosis received captopril during 26 periods of treatment. The mean dosage was 1.6 mg/kg (0.3-4.4). The result was excellent in 12 cases (normal BP without any RF), less good in 8 cases (moderate RF +/- borderline BP) and poor (acute RF) in 6. Sodium depletion, due to diuretics in 9, was present in all 14 cases with RF and in 10 of them captopril could be continued or reintroduced without any reappearance of RF after the correction of salt depletion. We conclude that sodium depletion is the main cause of renal failure in transplanted patients receiving captopril and that avoidance of diuretics largely diminishes the risk of RF.
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PMID:[Captopril treatment of arterial hypertension in children after renal transplantation]. 644 43

The authors report the results of percutaneous dilatation of renal artery stenoses, performed on 8 occasions in 7 patients. One patient had bilateral stenoses which were operated at two separate occasions. The authors had no complications and they confirm the stability of the results with a follow-up of up to 2 years. In the 4 cases with an isolated unilateral renal artery stenosis, dilatation of the artery led to normalization of the blood pressure within hours of the operation. When there was another cause for hypertension apart from the renal artery stenosis, the dilatation did not cause the blood pressure to return to normal, although the anatomical result was confirmed on arteriography. The authors then review the literature and compare the complications of surgery for renal artery stenoses with those occurring during or after percutaneous dilatation of the renal artery lumen. Because of the quality of the results, the complication rate and the good results obtained with percutaneous dilatation in the literature, the authors conclude that percutaneous dilatation of the renal artery lumen is the treatment of choice for these stenoses. The indication for this operation can be extended, as its aim is not only reduction of hypertension, but also to improve renal function and to avoid the risk of thrombosis on a very narrow stenosis. In this way, the indications for this operation extend to include a population which, up until now, has been excluded from surgery, such as elderly patients, patients with coronary disease, or with renal failure.
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PMID:[Percutaneous dilatation of renal artery stenoses. Apropos of 7 cases]. 663 Oct 39

The authors review the various techniques of intravenous arteriography before an excretory urogram and discuss their role in the etiological diagnosis of hypertension. Detection of renovascular disease classically implied Seldinger arteriography, with its limited indications, because of side effects and cost. This classical approach should now be systematically replaced by the visualization of renal arteries during the intravenous pyelography procedure which appears to be a method more effective, as well as less expensive and hazardous. The pyelogram wash-out should still be performed when the visualization of the renal arteries is poor because of its value in the screening for renovascular hypertension. Furthermore, when a renal artery stenosis is clearly defined, the wash-out of the pyelogram should also be performed because of its prognostic value. As the classical approach for the etiological diagnosis of hypertension, this technique has limited indications. It is indicated in severe hypertension in the young, when medical treatment does not control blood pressure satisfactorily or when renal failure progresses rapidly. Furthermore, this technique allows a non traumatic follow up of operated or dilated stenoses.
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PMID:[Intravenous pyelography with visualization of renal arteries and pyelogram wash-out, as the method of choice for the diagnosis of renovascular hypertension (author's transl)]. 680 7


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