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. 1984 Mar 24;288(6421):886–890. doi: 10.1136/bmj.288.6421.886

Splint renal function after captopril in unilateral renal artery stenosis.

G J Wenting, H L Tan-Tjiong, F H Derkx, J H de Bruyn, A J Man in't Veld, M A Schalekamp
PMCID: PMC1441698  PMID: 6423129

Abstract

The renal extraction ratios of 131I-sodium iodohippurate (131I-Hippuran) and 125I-thalamate were greatly reduced on the affected side by 50 mg captopril in seven out of 14 patients with unilateral renal artery stenosis. With long term captopril 150 mg daily the uptake of 99mTc-diethylenetriaminepenta-acetic acid by the affected kidney, which was determined by scintillation camera renography, became almost zero in these seven patients, indicating severe reduction of the glomerular filtration rate. Function of the affected kidney returned on discontinuing treatment. The reduced extraction of sodium iodohippurate probably reflected a shortened plasma transit time through the kidney due to intrarenal vasodilatation. The reduced extraction of thalamate reflected a low filtration fraction, suggesting that the vasodilatation was, at least in part, at the level of the postglomerular arterioles. Captopril had little effect on the contralateral kidney and on the kidneys of 17 patients with essential hypertension, and serum creatinine concentrations showed minor changes. Radioisotope renography should be performed after beginning captopril treatment in patients with renal artery stenosis. This is also recommended for patients given captopril as a third line drug when renal artery stenosis has not been excluded. Hypertension is these patients is often severe and difficult to control. Renal artery disease is not rare in this difficult group and finding seriously impaired renal function on one side during captopril treatment may be diagnostic.

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Selected References

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  1. Anderson W. P., Korner P. I., Johnston C. I. Acute angiotensin II-mediated restoration of distal renal artery pressure in renal artery stenosis and its relationship to the development of sustained one-kidney hypertension in conscious dogs. Hypertension. 1979 May-Jun;1(3):292–298. doi: 10.1161/01.hyp.1.3.292. [DOI] [PubMed] [Google Scholar]
  2. Anderson W. P., Korner P. I. The importance of renal vascular tone in determining the severity of renal artery stenosis in dogs. J Physiol. 1980 Aug;305:31–41. doi: 10.1113/jphysiol.1980.sp013347. [DOI] [PMC free article] [PubMed] [Google Scholar]
  3. Atkinson A. B., Brown J. J., Cumming A. M., Fraser R., Lever A. F., Leckie B. J., Morton J. J., Robertson J. I. Captopril in renovascular hypertension: long-term use in predicting surgical outcome. Br Med J (Clin Res Ed) 1982 Mar 6;284(6317):689–693. doi: 10.1136/bmj.284.6317.689. [DOI] [PMC free article] [PubMed] [Google Scholar]
  4. Bratt C. G., Larsson I., White T. Scintillation camera renography with 99mTc-DTPA and 131I-Hippuran. Scand J Clin Lab Invest. 1981 Apr;41(2):189–197. doi: 10.3109/00365518109092033. [DOI] [PubMed] [Google Scholar]
  5. Brenner B. M., Troy J. L., Daugharty T. M., Deen W. M., Robertson C. R. Dynamics of glomerular ultrafiltration in the rat. II. Plasma-flow dependence of GFR. Am J Physiol. 1972 Nov;223(5):1184–1190. doi: 10.1152/ajplegacy.1972.223.5.1184. [DOI] [PubMed] [Google Scholar]
  6. Case D. B., Atlas S. A., Laragh J. H., Sealey J. E., Sullivan P. A., McKinstry D. N. Clinical experience with blockade of the renin-angiotensin-aldosterone system by an oral converting-enzyme inhibitor (SQ 14,225, captopril) in hypertensive patients. Prog Cardiovasc Dis. 1978 Nov-Dec;21(3):195–206. doi: 10.1016/0033-0620(78)90025-7. [DOI] [PubMed] [Google Scholar]
  7. Collste P., Haglund K., Lundgren G., Magnusson G., Ostman J. Reversible renal failure during treatment with captopril. Br Med J. 1979 Sep 8;2(6190):612–613. doi: 10.1136/bmj.2.6190.612-c. [DOI] [PMC free article] [PubMed] [Google Scholar]
  8. Coulie P., De Plaen J. F., van Ypersele de Strihou C. Captopril-induced acute reversible renal failure. Nephron. 1983;35(2):108–111. doi: 10.1159/000183065. [DOI] [PubMed] [Google Scholar]
  9. Curtis J. J., Luke R. G., Whelchel J. D., Diethelm A. G., Jones P., Dustan H. P. Inhibition of angiotensin-converting enzyme in renal-transplant recipients with hypertension. N Engl J Med. 1983 Feb 17;308(7):377–381. doi: 10.1056/NEJM198302173080707. [DOI] [PubMed] [Google Scholar]
  10. Dean R. H., Kieffer R. W., Smith B. M., Oates J. A., Nadeau J. H., Hollifield J. W., DuPont W. D. Renovascular hypertension: anatomic and renal function changes during drug therapy. Arch Surg. 1981 Nov;116(11):1408–1415. doi: 10.1001/archsurg.1981.01380230032005. [DOI] [PubMed] [Google Scholar]
  11. Derkx F. H., Tan-Tjiong L., Wenting G. J., Boomsma F., Man in 't Veld A. J., Schalekamp M. A. Asynchronous changes in prorenin and renin secretion after captopril in patients with renal artery stenosis. Hypertension. 1983 Mar-Apr;5(2):244–256. doi: 10.1161/01.hyp.5.2.244. [DOI] [PubMed] [Google Scholar]
  12. Farrow P. R., Wilkinson R. Reversible renal failure during treatment with captopril. Br Med J. 1979 Jun 23;1(6179):1680–1680. doi: 10.1136/bmj.1.6179.1680. [DOI] [PMC free article] [PubMed] [Google Scholar]
  13. Gould K. L. Dynamic coronary stenosis. Am J Cardiol. 1980 Feb;45(2):286–292. doi: 10.1016/0002-9149(80)90647-5. [DOI] [PubMed] [Google Scholar]
  14. Hall J. E., Guyton A. C., Jackson T. E., Coleman T. G., Lohmeier T. E., Trippodo N. C. Control of glomerular filtration rate by renin-angiotensin system. Am J Physiol. 1977 Nov;233(5):F366–F372. doi: 10.1152/ajprenal.1977.233.5.F366. [DOI] [PubMed] [Google Scholar]
  15. Helmchen U., Gröne H. J., Kirchertz E. J., Bader H., Bohle R. M., Kneissler U., Khosla M. C. Contrasting renal effects of different antihypertensive agents in hypertensive rats with bilaterally constricted renal arteries. Kidney Int Suppl. 1982 Aug;12:S198–S205. [PubMed] [Google Scholar]
  16. Hricik D. E., Browning P. J., Kopelman R., Goorno W. E., Madias N. E., Dzau V. J. Captopril-induced functional renal insufficiency in patients with bilateral renal-artery stenoses or renal-artery stenosis in a solitary kidney. N Engl J Med. 1983 Feb 17;308(7):373–376. doi: 10.1056/NEJM198302173080706. [DOI] [PubMed] [Google Scholar]
  17. Nielsen S. P., Moller M. L., Trap-Jensen J. 99mTc-DTPA scintillation-camera renography: a new method for estimation of single-kidney function. J Nucl Med. 1977 Feb;18(2):112–117. [PubMed] [Google Scholar]
  18. Rafestin-Oblin M. E., Roth-Meyer C., Claire M., Michaud A., Baviera E., Brisset J. M., Corvol P. Are mineralocorticoid receptors present in human renal adenocarcinoma? Clin Sci (Lond) 1979 Nov;57(5):421–425. doi: 10.1042/cs0570421. [DOI] [PubMed] [Google Scholar]
  19. Schalekamp M. A., Birkenhäger W. H., Zaal G. A., Kolsters G. Haemodynamic characteristics of low-renin hypertension. Clin Sci Mol Med. 1977 Apr;52(4):405–412. doi: 10.1042/cs0520405. [DOI] [PubMed] [Google Scholar]
  20. Silas J. H., Klenka Z., Solomon S. A., Bone J. M. Captopril induced reversible renal failure: a marker of renal artery stenosis affecting a solitary kidney. Br Med J (Clin Res Ed) 1983 May 28;286(6379):1702–1703. doi: 10.1136/bmj.286.6379.1702-a. [DOI] [PMC free article] [PubMed] [Google Scholar]
  21. Staessen J., Bulpitt C., Fagard R., Lijnen P., Amery A. Long-term converting-enzyme inhibition as a guide to surgical curability of hypertension associated with renovascular disease. Am J Cardiol. 1983 May 1;51(8):1317–1322. doi: 10.1016/0002-9149(83)90305-3. [DOI] [PubMed] [Google Scholar]
  22. Velasquez M. T., Notargiacomo A. V., Cohn J. N. Influence of cortical plasma transit-time on p-aminohippurate extraction during induced renal vasodilatation in anaesthetized dogs. Clin Sci. 1972 Sep;43(3):401–411. doi: 10.1042/cs0430401. [DOI] [PubMed] [Google Scholar]
  23. Young D. F., Cholvin N. R., Kirkeeide R. L., Roth A. C. Hemodynamics of arterial stenoses at elevated flow rates. Circ Res. 1977 Jul;41(1):99–107. doi: 10.1161/01.res.41.1.99. [DOI] [PubMed] [Google Scholar]
  24. de Bruyn J. H., Man in't Veld A. J., Wenting G. J., Derkx F. H., Schalekamp M. A. Haemodynamic profile of captopril treatment in various forms of hypertension. Eur J Clin Pharmacol. 1981;20(3):163–168. doi: 10.1007/BF00544593. [DOI] [PubMed] [Google Scholar]

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