Rell K, Serafinowicz A, Gaciong Z, Michnowska M, Lao M
Instytutu Transplantologii Akademii Medycznej, Warszawie.
Pol Arch Med Wewn. 1993 May;89(5):405-9.
Treatment of kidney transplant recipients with inhibitors of angiotensin-converting enzyme (iACE) is associated with increased risk of deterioration of renal function. Between 1988-1992 in Transplantation Institute, 71 renal allograft recipients were treated with iACE. 44 of them received iACE in order to reduce proteinuria, 18 due to secondary polycythemia and 9 recipients received iACE because of hypertension resistant to at least 3 hypotensive drugs. Acute renal failure developed in 5 patients and all of them received iACE as treatment of resistant hypertension. After resumption of renal function, in 3 of 5 patients artery stenosis of the transplanted kidney was found. In 1 recipient acute renal failure occurred despite normal renal arteriography and normal indexes of the flow through renal arteries determined by Doppler ultrasound examination. In 2 patients acute renal failure appeared after a single minimal dose of iACE. Severe arterial hypertension in patients with transplanted kidney is a particular risk factor for development of acute renal failure after iACE. The normal arteriography in transplanted kidney and normal arterial blood flow measured by means of Doppler ultrasound do not exclude the possibility of development of acute renal failure after iACE.
用血管紧张素转换酶抑制剂（iACE）治疗肾移植受者与肾功能恶化风险增加相关。1988年至1992年间，在移植研究所，71例肾移植受者接受了iACE治疗。其中44例接受iACE是为了减少蛋白尿，18例是由于继发性红细胞增多症，9例受者接受iACE是因为对至少3种降压药耐药的高血压。5例患者发生了急性肾衰竭，他们均接受iACE治疗耐药性高血压。肾功能恢复后，5例患者中有3例发现移植肾动脉狭窄。1例受者尽管肾动脉造影正常且经多普勒超声检查测定的肾动脉血流指标正常，但仍发生了急性肾衰竭。2例患者在单次最小剂量的iACE后出现急性肾衰竭。移植肾患者的重度动脉高血压是iACE治疗后发生急性肾衰竭的一个特殊危险因素。移植肾动脉造影正常且通过多普勒超声测量的动脉血流正常并不能排除iACE治疗后发生急性肾衰竭的可能性。
