Abstract | OBJECTIVE: DESIGN: SETTING: Hospital-based outpatient treatment center. INTERVENTIONS: MEASUREMENTS: Blood pressure and serum creatinine levels were measured, and imaging studies of the main renal arteries were done. MAIN RESULTS: In group 1, eight of 42 patients (19%, 95% CI, 9% to 34%) developed reversible renal insufficiency, defined as an unexpected increase in serum creatinine of 88 mumol/L or higher. Six episodes of reversible renal insufficiency occurred during July and August when temperatures were 32.2 degrees C to 37.8 degrees C (90 degrees F to 100 degrees F). Renal artery stenosis was excluded by renal arteriogram or ultrasonic duplex scanning. All eight group-1 patients had a significant decrease in mean arterial pressure below their baseline level during reversible renal insufficiency (mean change, -28 +/- 10 mm Hg, P less than 0.001). The increase in the serum creatinine level was inversely correlated with the decrease in the mean arterial pressure (r = -0.68, P less than 0.01). Reversible renal insufficiency was successfully managed by withdrawing or reducing enalapril as well as other antihypertensive agents. Subsequently, enalapril was tolerated by seven of the eight patients without recurrence of renal insufficiency. In contrast, none of 31 (CI, 0% to 11%) patients in group 2 developed reversible renal insufficiency despite the fact that both the incidence of decreases in mean arterial pressure in 6 of 31 patients (19%) and the magnitude of the decreases in mean arterial pressure (mean change, -33 +/- 16 mm Hg) were similar to those observed in group 1. CONCLUSIONS:
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Authors | R D Toto, H C Mitchell, H C Lee, C Milam, W A Pettinger |
Journal | Annals of internal medicine
(Ann Intern Med)
Vol. 115
Issue 7
Pg. 513-9
(Oct 01 1991)
ISSN: 0003-4819 [Print] United States |
PMID | 1883120
(Publication Type: Clinical Trial, Journal Article, Randomized Controlled Trial, Research Support, Non-U.S. Gov't, Research Support, U.S. Gov't, P.H.S.)
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Chemical References |
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Topics |
- Aged
- Blood Pressure
(drug effects)
- Creatinine
(blood)
- Double-Blind Method
- Enalapril
(adverse effects)
- Female
- Glomerular Filtration Rate
(drug effects)
- Humans
- Hypertension, Renal
(drug therapy, physiopathology)
- Kidney Diseases
(blood, chemically induced, physiopathology)
- Male
- Middle Aged
- Nephrosclerosis
(drug therapy, physiopathology)
- Radiography
- Renal Artery
(diagnostic imaging)
- Retrospective Studies
- Ultrasonography
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