Fabiano Valentina, Carnovale Carla, Gentili Marta, Radice Sonia, Zuccotti Gian Vincenzo, Clementi Emilio, Perrotta Cristiana, Mameli Chiara
Université degli Studi di Milano, Department of Pediatrics, Children's Hospital V. Buzzi, Milan, Italy.
Pharmacology. 2016;97(1-2):38-42. doi: 10.1159/000441950. Epub 2015 Nov 18.
The use of angiotensin converting enzyme (ACE) inhibitors in combination with diuretics is a common strategy used for the treatment of patients affected by heart failure. An infant affected by initial congestive cardiac failure, after starting the treatment with enalapril in association with furosemide, developed acute kidney injury (AKI). No underlying renal disease or renal artery stenosis was found. He recovered from kidney injury after the therapy was suspended, thus suggesting that the drug combination is responsible for the onset of the adverse reaction. The present case report, the appraisal of the current knowledge on the onset of AKI and the analysis of available pharmacovigilance databases indicate that particular caution should be exercised when infants affected by heart failure are treated with the enalapril and furosemide combination therapy. Moreover, we strongly suggest an up-to-date revision of the ACE-inhibitor dosing guidelines in pediatric patients to define unambiguously the safe upper limits of this class of drugs.
血管紧张素转换酶（ACE）抑制剂与利尿剂联合使用是治疗心力衰竭患者的常用策略。一名初发充血性心力衰竭的婴儿，在开始使用依那普利联合呋塞米治疗后，发生了急性肾损伤（AKI）。未发现潜在的肾脏疾病或肾动脉狭窄。在治疗暂停后，他从肾损伤中恢复，这表明药物联合使用是不良反应发生的原因。本病例报告、对当前关于AKI发病机制的知识评估以及对现有药物警戒数据库的分析表明，在对心力衰竭婴儿进行依那普利和呋塞米联合治疗时应格外谨慎。此外，我们强烈建议对儿科患者的ACE抑制剂给药指南进行更新修订，以明确界定这类药物的安全上限。
