enalapril and Takayasu-Arteritis

The case of a 19 year old patient with Takayasu arteritis with exclusive involvement of the abdominal aorta and without involvement of the renal arteries who presented severe arterial hypertension during the acute phase of the disease is referred. The administration of a dose of 20 mg of enalapril maleate was followed in less than 24 hours by lameness of the lower limbs and acute oligoanuric renal failure, both of which were reversible after discontinuation of the drug. During the inflammatory phase of the disease, treatment with high doses of prednisone was effective in the control of the general symptoms and the biologic parameters of inflammation. Surgical revascularization was successfully carried out 5 months after diagnosis. Two years later the patient continues to be normotense and asymptomatic.

Topics: Acute Kidney Injury; Adult; Enalapril; Female; Humans; Takayasu Arteritis

Prognosis in Takayasu's arteritis is limited owing to renovascular hypertension. The authors report a patient with Takayasu's arteritis who had been unilaterally nephrectomized and presented with malignant hypertension due to renal artery stenosis. Hypertension was refractory to conventional antihypertensive treatment, and stenosis was not accessible by interventional angioplasty. Initiation of enalapril and losartan therapy was successful in improving blood pressure without deterioration of renal function due to ischemic failure. Antihypertensive treatment resulted in dramatically stimulated endogenous nitric oxide (NO) synthesis, while elevated plasma endothelin-1 levels were unchanged. Renovascular hypertension in Takayasu's arteritis is associated with an imbalance of vasoconstrictor peptide endothelin-1 and vasodilator peptide NO. Successful treatment of hypertension by enalapril or losartan results in improved endogenous NO synthesis, which putatively counterbalances excessive vasoconstrictor actions and may retard the progression of renal failure.

Topics: Angiotensin-Converting Enzyme Inhibitors; Antihypertensive Agents; Enalapril; Endothelin-1; Female; Humans; Hypertension, Renovascular; Losartan; Middle Aged; Nephrectomy; Nitric Oxide; Prognosis; Renal Artery Obstruction; Takayasu Arteritis; Vasoconstrictor Agents; Vasodilator Agents

Successful bilateral renal revascularization was performed 24 days after the development of angiotensin converting enzyme-inhibitor-induced bilateral renal artery thrombosis and anuric acute renal failure in a patient with Takayasu's arteritis. Excellent results were obtained after an unusually long ischemic time for a patient with active-phase disease. The outcome suggests that aggressive surgical revascularization can benefit patients with renal failure caused by renal arterial occlusion during the active phase of Takayasu's arteritis.

Topics: Acute Kidney Injury; Adult; Angiotensin-Converting Enzyme Inhibitors; Anuria; Collateral Circulation; Enalapril; Female; Humans; Radiography; Renal Artery Obstruction; Takayasu Arteritis; Thrombosis