Key result
Captopril increases renal plasma flow ~23% in Bartter's syndrome, an effect abolished by indomethacin.
Why the study?
Does prostaglandin synthetase inhibition with indomethacin alter captopril-induced changes in renal function and the renin-angiotensin system in patients with Bartter's syndrome?
Does prostaglandin synthetase inhibition with indomethacin alter captopril-induced changes in renal function and the renin-angiotensin system in patients with Bartter's syndrome?
In patients with Bartter's syndrome, the renal vasodilatory and renin-stimulating effects of captopril are prostaglandin-dependent and are abolished by indomethacin.
Answers are grounded in this paper and cite their sources.
Indomethacin may blunt captopril renal effects in Bartter syndrome; hypothesis-generating and should not yet change practice.
Three patients with Bartter's syndrome were studied under metabolic ward conditions. Renal function and the renin-angiotensin system were evaluated in three different settings: before and during captopril treatment and during administration of captopril and indomethacin. Captopril induced renal vasodilation with an increase in renal plasma flow by 23%. The addition of idomethacin abolished this change. Captopril increased the release of renin and the concentration of angiotensin II in plasma decreased without being completely normalized. Indomethacin thereafter reduced plasma concentration of renin, which was, however, still higher than the control level. The plasma concentration of angiotensin II did not change significantly. In conclusion, prostaglandin synthetase inhibition annihilated the effect of captopril on renal hemodynamics and renin release.
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Rudin et al. (1984) studied Bartter's syndrome (n=3). Captopril and indomethacin vs. Captopril alone and baseline (before treatment) was evaluated on Renal function (renal plasma flow) and the renin-angiotensin system (plasma renin and angiotensin II concentrations). Captopril increased renal plasma flow by 23% in patients with Bartter's syndrome, an effect completely abolished by the addition of indomethacin.
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