Repeated renal failure with use of captopril in a cystinotic renal allograft recipient.

Abstract

B catarrhalis was isolated from transtracheal aspirates in 10 out of 11 patients in whom B catarrhalis was identified in sputum before transtracheal puncture. We conclude that the method of sputum examination which we describe is reliable in detecting lower respiratory tract infections with B catarrhalis in clinical practice without the need for transtracheal puncture.

Captopril-Associated Acute Interstitial Nephritis

“…Including the present case, eight episodes of acute renal failure secondary to captopril-induced acute inter stitial nephritis have been reported in 6 patients, if one accepts the first two episodes in the case reported by Hooke et al [13] as due to the same etiology. The dura tion of captopril therapy in all was rather brief, ranging from 2 to 47 days prior to clinical detection of renal failure and cessation of therapy.…”

“…Hooke et al [ 13] described recurrent renal failure in a renal allograft recipient on each of three occasions fol lowing captopril administration. During the third trial of captopril renal failure requiring peritoneal dialysis de veloped.…”

“…The clinical situations in which this occurs include (l) bilateral or unilateral renal artery stenosis in a solitary functioning kidney [5,6]; (2) congestive heart failure [7][8][9][10], and (3) the newborn period [11], In all of these circumstances reversible renal failure has been noted with ACE inhibitors as a class, and renal function improves within several days of either discontinuing the offending drug, stopping concomitant diuretics, or insti tution of volume expansion. Recent evidence suggests that ACE inhibitor mediated renal prostaglandin stimu lation may contribute to the decreased glomerular filtra tion rate by promoting a natriuresis with consequent vol ume depletion and by decreased renal plasma flow [6], Less frequently captopril, a sulfhydryl-containing ACE inhibitor, has been reported to induce an allergic interstitial nephritis with systemic features suggestive of a hypersensitivity reaction, including fever, a maculopapular rash, eosinophilia, and a Coombs-positive he- molytic anemia [12][13][14][15][16]. Only a few reported cases include renal biopsy material [13,14].…”

“…Recent evidence suggests that ACE inhibitor mediated renal prostaglandin stimu lation may contribute to the decreased glomerular filtra tion rate by promoting a natriuresis with consequent vol ume depletion and by decreased renal plasma flow [6], Less frequently captopril, a sulfhydryl-containing ACE inhibitor, has been reported to induce an allergic interstitial nephritis with systemic features suggestive of a hypersensitivity reaction, including fever, a maculopapular rash, eosinophilia, and a Coombs-positive he- molytic anemia [12][13][14][15][16]. Only a few reported cases include renal biopsy material [13,14]. The present re port describes such a patient in whom reversible renal failure, in association with a generalized desquamative maculopapular rash and eosinophilia, developed after initiation of captopril and in whom renal biopsy re vealed an acute interstitial nephritis.…”

Renal injury from angiotensin I converting enzyme inhibitors

“…In both patients the nephrotic range proteinuria persisted despite discontinuation of captopril and treatment with prednisolone [12]. Four other cases of acute interstitial nephritis with eosinophils have been described, mostly after usual doses of captopril (50-125 mg) given for a few days or weeks [13][14][15][16]. In one patient renal interstitial granulomas were also found [15].…”