Abstract
The occurrence of severe acute renal failure in 3 patients who developed diarrhoea while taking angiotensin converting enzyme (ACE) inhibitors led us to undertake a retrospective cohort survey to determine the frequency with which diarrhoea and vomiting are associated with acute renal failure in patients taking this class of drug. Serum creatinine was measured as part of the diagnostic workup of 2398 consecutive admissions to an acute medical receiving unit in a district general hospital. Outcome measures were the presence of diarrhoea and/or vomiting, and whether taking an ACE inhibitor, NSAID or diuretic at the time of admission, also previous, initial and follow up serum creatinine concentrations. Peak serum creatinine in the 3 cases was 1159, 989 and 765 μmol/l. None of the 3 required dialysis and all recovered renal function completely after receiving large volumes of intravenous fluid. In the cohort study, 89 of 2398(3.7%) admissions had serum creatinine ⩾200 μmol/l. Nine were regular dialysis patients. Of the remaining patients, 30 (37.5%) were taking an ACE inhibitor. Six of 30 (20%) gave a history of diarrhoea and/or vomiting. Median creatinine concentration in this group was 135 (range 111–209) μmol/l before admission, 292 (216–724) μmol/l when first seen in hospital, and 134 (94–219) μmol/l following the withdrawal of drug therapy and fluid replacement. In conclusion, volume depletion causing acute renal failure in patients taking ACE inhibitors is not uncommon. Such patients and their general practitioners should be aware that reversible renal impairment may occur during intercurrent illnesses, particularly if characterised by diarrhoea and/or vomiting.
This is a preview of subscription content, access via your institution
Access options
Subscribe to this journal
Receive 12 digital issues and online access to articles
$119.00 per year
only $9.92 per issue
Buy this article
- Purchase on Springer Link
- Instant access to full article PDF
Prices may be subject to local taxes which are calculated during checkout
Similar content being viewed by others
References
Kshirsagar AV et al. Effect of ACE inhibitors in diabetic and nondiabetic chronic renal disease: a systematic overview of randomized placebo-controlled trials. Am J Kidney Dis 2000; 35: 695–707.
Flather MD et al. Long-term ACE-inhibitor therapy in patients with heart failure or left-ventricular dysfunction: a systematic overview of data from individual patients ACE-Inhibitor Myocardial Infarction Collaborative Group. Lancet 2000; 355: 1575–1581.
Yusuf S et al. Effects of an angiotensin-converting-enzyme inhibitor, Ramipril, on cardiovascular events in high risk patients. The Heart Outcomes Prevention Evaluation Study Investigators. N Engl J Med 2000; 342: 145–153.
PROGRESS Collaborative Group. Randomised trial of a perindopril-based blood-pressure-lowering regimen among 6,105 individuals with previous stroke or transient ischaemic attack. Lancet 2001; 358: 1033–1041.
Toto RD . Renal insufficiency due to ACE inhibitors. Miner Electrolyte Metab 1994; 20: 193–200.
Van de Ven PJG et al. Angiotensin converting enzyme inhibitor induced renal dysfunction in atherosclerotic renovascular disease. Kidney Int 1998; 53: 986–993.
Thomas MC . Diuretics, ACE inhibitors and NSAIDs —the triple whammy. Med J Aust 2000; 172: 184–185.
Knight EI et al. Predictors of decreased renal function in patients with heart failure during angiotensin converting enzyme inhibitor therapy: results from the Studies of Left Ventricular Dysfunction (SOLVD). Am Heart J 1999; 138: 849–855.
Baraldi A et al. Acute renal failure of medical type in an elderly population. Nephrol Dial Transplant 1998; 13 (Suppl 7): 25–29.
Wynckel A et al. Long term follow up of acute renal failure caused by angiotensin converting enzyme inhibitors. Am J Hypertens 1998; 11: 1080–1086.
Pitt B et al on behalf of the ELITE Study Investigators. Randomised trial of losartan versus captopril in patients over 65 with heart failure. Evaluation of Losartan In The Elderly Study (ELITE). Lancet 1997; 249: 747–752.
Bakris GL, Weir MR . Angiotensin-converting enzyme inhibitor—associated elevations in serum creatinine. Is this a cause for concern? Arch Intern Med 2000; 160: 685–693.
Short A, Cumming A . ABC of intensive care: renal support. BMJ 1999; 319: 41–44.
Bennett PR, Cairns SA . Captopril, diarrhoea and hypotension. Lancet 1985; i: 1105.
McMurray J, Matthews DM . Consequences of fluid loss in patients treated with ACE inhibitors. Postgrad Med J 1987; 63: 385–387.
Osterziel KJ, Dietz R . Improvement of vagal tone by ACE inhibition: a mechanism of cardioprotection in patients with mild to moderate heart failure. J Cardiovas Pharmacol 1996; 27 (Supp 2): 25–30.
Grassi G et al. Effects of chronic ACE inhibition on sympathetic nerve traffic and baroreflex control of circulation in heart failure. Circulation 1997; 96: 1173–1179.
Kalra PA, Kumwenda M, Macdowall P, Rowland MO . Questionnaire study and audit of use of angiotensin converting enzyme inhibitor and monitoring in general practice: the need for guidelines to prevent renal failure. BMJ 1999; 318: 234–237.
Acknowledgements
We thank Mrs Josephine Campbell and Mrs Anne Bray for their help in the preparation of this manuscript and Dr Robert McFadzean for his helpful advice. This work was supported in part by an infrastructure grant from the Chief Scientist Office, Scotland.
Author information
Authors and Affiliations
Corresponding author
Rights and permissions
About this article
Cite this article
Stirling, C., Houston, J., Robertson, S. et al. Diarrhoea, vomiting and ACE inhibitors: – an important cause of acute renal failure. J Hum Hypertens 17, 419–423 (2003). https://doi.org/10.1038/sj.jhh.1001571
Received:
Accepted:
Published:
Issue Date:
DOI: https://doi.org/10.1038/sj.jhh.1001571
Keywords
This article is cited by
-
Hospital admissions associated with dehydration in childhood kidney transplantation
Pediatric Nephrology (2024)
-
Lithium Toxicity from the Addition of an ACE Inhibitor with an Unexpected Type I Brugada Pattern ECG: Case Files of the Medical Toxicology Fellowship at the University of California, San Diego
Journal of Medical Toxicology (2020)
-
Preventing acute kidney injury in high-risk patients by temporarily discontinuing medication – an observational study in general practice
BMC Nephrology (2019)
-
Acute Kidney Injury Due to Diarrheal Illness Requiring Hospitalization: Data from the National Inpatient Sample
Journal of General Internal Medicine (2018)
-
Lower blood pressure and risk of cisplatin nephrotoxicity: a retrospective cohort study
BMC Cancer (2017)