INITIAL EFFECT OF ENALAPRIL ON KIDNEY-FUNCTION IN PATIENTS WITH MODERATE TO SEVERE CHRONIC NEPHROPATHY

Angiotensin converting enzyme (ACE) inhibitors has been suggested to halt the progression of chronic renal failure. As the initial step of a controlled trial of this hypothesis, it was investigated whether start of enalapril in patients with severe chronic nephropathy might cause a critical fall in their renal function. Thirty-one patients were studied, 26 on chronic antihypertensive treatment with drugs other than ACE inhibitors and 5 untreated normotensive. 51Cr-EDTA plasma clearance and renal technetium-99m dimercaptosuccinic acid (99mTc-DMSA) scintigraphy were made before and 24 h after start of enalapril, mean dose 9 mg, Blood pressure fell from median 148/88 to 119/78 mm Hg (p<0.01). Glomerular filtration rate (GFR) fell from median 14 to 12 ml/min/1.73 m2 (p<0.01). The median change in GFR was -14% (range -44% to + 10%). The split renal function was unchanged and the scintigrams showed no intrarenal activity defects. In conclusion, enalapril caused a fall in GFR, which was clinically acceptable in most of the patients. © 1990 Informa UK Ltd.