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

Keywords
Late onset renal failure
RAAS blockers
Lorffab syndrome
Chronic kidney disease
ARB
ACEi

How to Cite

1.
Villegas I, Quintero E, Arrieta A, Leclercq R, Pérez L. Late-onset renal failure because of angiotensin blockade in 51 patients with chronic kidney disease. Rev. Colomb. Nefrol. [Internet]. 2016 Jul. 11 [cited 2024 May 20];3(1):20-5. Available from: https://revistanefrologia.org/index.php/rcn/article/view/237

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(73%), diabetes in 11 (22%), chronic glomerulo nephritis in 1 (2%) and unknown origin in 2 (3%).ACE-i or ARB were withdrawn:losartan in 34 patients (67%), enalapril in 13 (25%), irbesartan in 2 (4%), captopril and telmisartan in 1 (2%).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.

https://doi.org/10.22265/acnef.3.1.237
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References

1. Toto RD, Mitchell HC, Lee HC, Milam C, Pettinger WA. Reversible renal insufficiency due to angiotensin converting enzyme inhibitors in hypertensive nephrosclerosis. Ann Intern Med. 1991 Oct 1;115(7):513–9.

2. Bakris GL, Weir MR. Angiotensin-converting enzyme inhibitor-associated elevations in serum creatinine: is this a cause for concern? Arch Intern Med. 2000 Mar 13;160(5):685–93.

3. Onuigbo MA, Onuigbo NT. Late-onset renal failure from angiotensin blockade (LORFFAB) in 100 CKD patients. Int Urol Nephrol 2008;40(1):233–9. doi: 10.1007/s11255-007-9299-2. Epub 2008 Ene 15.

4. Yusuf S, Teo KK, Pogue J, Dyal L, Copland I, Schumacher H, et al. Telmisartan, ramipril, or both in patients at high risk for vascular events. N Engl J Med. 2008 Abr 10;358(15):1547–59. doi: 10.1056/NEJMoa0801317. Epub 2008 Mar 31.
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