Speirs C J, Dollery C T, Inman W H, Rawson N S, Wilton L V
Department of Clinical Pharmacology, Royal Postgraduate Medical School, London.
BMJ. 1988 Oct 1;297(6652):830-2. doi: 10.1136/bmj.297.6652.830.
The possibility that enalapril might damage renal function was investigated in 1098 deaths recorded in a prescription-event monitoring study. Case notes for 913 patients were examined. In seventy five there was a rise in the urea or creatinine concentration of 50% or more above pretreatment values. Enalapril appeared to have contributed to a decline in renal function and subsequent death in 10 of these patients. Several characteristics were identified among these patients, including old age, the use of high dose or potassium sparing diuretics, and pre-existing renal disease. Adding a non-steroidal anti-inflammatory drug was also associated with a deterioration in patients with previously stable renal function. No death was encountered of a patient with uncomplicated hypertension. Enalapril infrequently contributed to a substantial decline in renal function in certain vulnerable patients, especially those receiving other drugs known to be capable of adversely affecting renal function. Awareness of the characteristics of these patients and of their concomitant treatment may serve to reduce the risk.
在一项处方事件监测研究记录的1098例死亡病例中，对依那普利可能损害肾功能的可能性进行了调查。检查了913例患者的病历。其中75例患者的尿素或肌酐浓度比治疗前值升高了50%或更多。在这些患者中，有10例患者的肾功能下降及随后的死亡似乎与依那普利有关。在这些患者中发现了几个特征，包括老年、使用高剂量或保钾利尿剂以及既往存在的肾脏疾病。加用非甾体抗炎药也与既往肾功能稳定的患者病情恶化有关。未发现单纯高血压患者死亡。依那普利很少导致某些易感患者的肾功能大幅下降，尤其是那些正在接受已知会对肾功能产生不利影响的其他药物治疗的患者。了解这些患者的特征及其同时进行的治疗可能有助于降低风险。
