Late-onset renal failure because of angiotensin blockade in 51 patients with chronic kidney disease

Abstract

Introduction: In this research, we describe the outcome of the glomerular filtration rate (GFR) in patients with hypertension and chronic kidney disease(CKD), in whom the angiotensin converting enzyme inhibitors (ACE-i) or angiotensin receptor blockers (ARB) were suspended after sudden deterioration of their GFR; this information is based on the Onuigbo 2005 report related to late onset renal failure after angiotensin blockade (so called Lorffab syndrome).

Materials and methods:a series of Hispanic patients attended in an outpatient department were followed in a clinic of prevention of kidney disease, with hypertension and stable CKD stages 3 and 4, who suffered a sudden deterioration of unknown origin of their GFR, and who were followed prospectively after with-drawing ACE-i or ARB.

Results: 51 patients were sampled, the mean age 81 years (SD 7); 32 females (63%)were followed-up after withdrawing the above medications during 240 days (of 129). As a result, their CKD were due to hyperten-sive nephrosclerosis in 37 patients (73%), diabetes in 11 (22%), chronic glomerulo nephritis in 1 (2%) and unknown origin in 2 (3%).ACE-i or ARB were withdrawn:losartan in 34 patients (67%), enalapril in 13 (25%), irbesartan in 2 (4%), captopril and telmisartan in 1 (2%). A Doppler ultrasound of renal arteries after Lorfabb syndrome was sus-pected were normal in 17 of the 17 cases performed. Compared to baseline measurements, GFR improved in 35 patients (69%), was stable in 7 (14%) and worsened in 9 (18%).

Conclusions: In very old hypertensive patients with stages 3 and 4 of CKD who were taking ACE-i or ARB, presented with sudden deterioration of their GFR; there was an improvement in kidney function after withdrawing these medications. However, some bias to these results are the low number of patients and that Doppler ultrasound was performed in only 33% of patients.Our observations ask for further studies.