Renal failure due to enalapril and captopril in bilateral renal artery stenosis: greater awareness needed.

Deterioration in renal function after the use of angiotensin converting-enzyme inhibitors may be the first clue to the presence of bilateral renal arterial stenosis. In order to avoid serious threat to the patient, early detection of the insidious decline in renal function is necessary and depends on routine biochemical monitoring after the initiation of therapy. Six cases are described here, to illustrate the very real danger of this class of drugs in this chemical setting; the grave risk of their combination with potassium-sparing diuretic agents is highlighted.