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December 1, 1992Journal of Internal Medicine

Deterioration in renal function associated with angiotensin converting enzyme inhibitor therapy is not always reversible

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Why the study?

Does ACE inhibitor therapy cause irreversible deterioration in renal function in patients with vascular disease or preexisting renal impairment?

Population

n=15 patients presenting with deterioration in renal function coincident with the introduction of…

Design

Case_series

Authors

MDMichael DevoyCTCharles TomsonMEM. E. Edmunds

Discussion

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Overview

May cause irreversible renal failure after ACE inhibitor start in high-risk patients; case reports leave open incidence and causality.

Key Points

  • To describe clinical characteristics and outcomes of patients experiencing irreversible renal deterioration after starting angiotensin converting enzyme inhibitor therapy.
  • Reviewed 15 patients presenting with acute deterioration in renal function coincident with ACE inhibitor initiation between January 1986 and January 1991.
  • Documented underlying comorbidities, including preexisting renal impairment (n=13) and extrarenal vascular disease (n=12).
  • Four patients became dialysis-dependent and died within 4 weeks of presentation.
  • Five patients required temporary dialysis, and serum creatinine remained elevated above baseline levels in seven patients.

Structured PICO

Does ACE inhibitor therapy cause irreversible deterioration in renal function in patients with vascular disease or preexisting renal impairment?

P
Population
n=15 patients presenting with deterioration in renal function coincident with the introduction of angiotensin converting enzyme (ACE) inhibitors. 12 had extrarenal vascular disease and 13 had preexisting renal impairment.
I
Intervention
Angiotensin converting enzyme (ACE) inhibitors
O
Outcome
Irreversible deterioration in renal function (dialysis dependence, death, elevated serum creatinine)safety

Deterioration in renal function following ACE inhibitor initiation is not always reversible, highlighting the need for extreme caution in patients with likely atherosclerotic vascular disease.

Cite This Study

Devoy et al. (1992) studied this question.

synapsesocial.com/papers/6a7323cc9114ba2b47c231behttps://doi.org/10.1111/j.1365-2796.1992.tb00622.x
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