Kalra P A, Mamtora H, Holmes A M, Waldek S
Renal Unit, Hope Hospital, University of Manchester, Salford.
Q J Med. 1990 Oct;77(282):1013-8. doi: 10.1093/qjmed/77.1.1013.
Renal complications of angiotensin-converting enzyme (ACE) inhibitor therapy are widely recognized, but few authors have documented the incidence or spectrum of these conditions. In a retrospective study of 530 consecutive patients presenting to our unit as acute uraemic emergencies over a six-year period, 85 (16 per cent) had renovascular disease that was considered to be responsible for their loss of renal function. Twenty-one (4 per cent) patients had uraemia which could be clearly attributable to ACE inhibitor treatment; 18 of these cases were shown to have significant renovascular pathology. Following withdrawal of the ACE inhibitor the renal failure reversed in the majority of patients. We also examined 400 consecutive hypertensive patients referred over a similar period and, although vascular imaging was performed only when it was considered to be clinically indicated, 58 (14.5 per cent) of these patients were shown to have renovascular pathology. A further five patients with stable chronic renal disease were seen to have a deterioration in their glomerular filtration rate coincident with commencement of ACE inhibitor therapy; this reversed when the agents were withdrawn. These observations indicate that significant renovascular disease may be more common than has been hitherto recognized and that injudicious use of ACE inhibitors may result in serious complications. Methods which may minimize such iatrogenic disease are suggested.
血管紧张素转换酶（ACE）抑制剂治疗的肾脏并发症已广为人知，但鲜有作者记录这些病症的发病率或范围。在一项对连续6年以急性尿毒症急症前来我院就诊的530例患者的回顾性研究中，85例（16%）患有肾血管疾病，被认为是其肾功能丧失的原因。21例（4%）患者的尿毒症可明确归因于ACE抑制剂治疗；其中18例显示有明显的肾血管病变。停用ACE抑制剂后，大多数患者的肾衰竭得到逆转。我们还检查了同期连续转诊的400例高血压患者，尽管仅在临床认为有必要时才进行血管成像检查，但其中58例（14.5%）患者显示有肾血管病变。另有5例稳定的慢性肾病患者在开始ACE抑制剂治疗后肾小球滤过率出现恶化；停用这些药物后病情逆转。这些观察结果表明，严重的肾血管疾病可能比迄今所认识到的更为常见，且不合理使用ACE抑制剂可能导致严重并发症。本文提出了可将此类医源性疾病降至最低的方法。
