Titre du document / Document title

Late onset renal failure from angiotensin blockade (LORFFAB) : a prospective thirty-month mayo health System clinic experience

Auteur(s) / Author(s)

ONULGBO Macaulay A. C. ; ONULGBO Nnonyelum T. C. ;

Résumé / Abstract

Background: Worsening azotemia following initiation ofangiotensin blockade (AB), in patients with CKD, RAS with/without precipitating factors is recognized. Small increases in serum creatinine following initiation ofAB occur and must not warrant drug discontinuation. We anecdotally had observed improvement in CKD in patients with normal renal arteries and no precipitating factors, following termination ofAB. The worldwide ESRD epidemic, coincident with increasing use ofAB, prompted us to hypothesize a late-onset azotemia in such CKD patients. aterial/Methods: Over 30 months, 103 patients with worsening azotemia, while on AB were evaluated. Ninety-seven patients with abnormal MRA and/or with precipitating factors were excluded. In the remaining five, AB was discontinued, and GFR monitored. Results: One male, four females, mean age 66.2 years. Three diabetic/hypertensives, one SLE/hypertensive, one diabetic/kidney transplant recipient. Mean stable AB, 25.2 months, (6-66 months). Mean follow up, 11.8 months. One month following discontinuation ofAB, GFR increased by a mean 45%. Mean serum crealinine decreased from 2.9′0.9 to 1.8′0.4 mg/dL (p=0.04). Uremic symptoms in 3, hyperkalemia in one, secondary hyperparathyroidism in one, resolved. Two with anemia, now require less erythropoietin. Conclusions: We called this unrecognized potentially reversible late-onset worsening azotemia, occurring several months to years on stable AB, in CKD patients with normal renal arteries, without precipitating factors. late-onset renal failure from angiotensin blockade (LORFFAB). Pathophysiologically, the concept of microvascular RAS is invoked. The extent of LORFFAB, with millions of patients worldwide on AB, remains conjectural and warrants further investigation.

Revue / Journal Title

Medical science monitor   ISSN 1234-1010 

Source / Source

2005, vol. 11, n^o10, pp. CR462-CR469

Langue / Language

Anglais

Editeur / Publisher

International Scientific Literatur Inc., Albertson, NY, ETATS-UNIS  (1995) (Revue)

Mots-clés d'auteur / Author Keywords

renal failure ; ACE inhibitor ; angiotensin receptor blocker ; hypertension ; diabetes mellitus ; renal artery stenosis ;

Localisation / Location

INIST-CNRS, Cote INIST : 27627, 35400013546107.0070