Diarrhoea, vomiting and ACE inhibitors: an important cause of acute renal failure

C. Stirling, J. Houston, S. Robertson, J. Boyle, A. Allan, John David Norrie, C. G. Isles

    Research output: Contribution to journalArticle

    28 Citations (Scopus)

    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 mumol/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 greater than or equal to200 mumol/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) mumol/l before admission, 292 (216-724) mumol/l when first seen in hospital, and 134 (94-219) mumol/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.

    Original languageEnglish
    Pages (from-to)419-423
    Number of pages4
    JournalJournal of Human Hypertension
    Volume17
    DOIs
    Publication statusPublished - 2003

    Keywords

    • acute renal failure
    • ACE inhibitors
    • diarrhoea
    • vomiting
    • CONVERTING-ENZYME-INHIBITOR
    • LEFT-VENTRICULAR DYSFUNCTION
    • HEART-FAILURE
    • THERAPY
    • DISEASE

    Cite this

    Stirling, C., Houston, J., Robertson, S., Boyle, J., Allan, A., Norrie, J. D., & Isles, C. G. (2003). Diarrhoea, vomiting and ACE inhibitors: an important cause of acute renal failure. Journal of Human Hypertension, 17, 419-423. https://doi.org/10.1038/sj.jhh.1001571

    Diarrhoea, vomiting and ACE inhibitors: an important cause of acute renal failure. / Stirling, C.; Houston, J.; Robertson, S.; Boyle, J.; Allan, A.; Norrie, John David; Isles, C. G.

    In: Journal of Human Hypertension, Vol. 17, 2003, p. 419-423.

    Research output: Contribution to journalArticle

    Stirling, C, Houston, J, Robertson, S, Boyle, J, Allan, A, Norrie, JD & Isles, CG 2003, 'Diarrhoea, vomiting and ACE inhibitors: an important cause of acute renal failure', Journal of Human Hypertension, vol. 17, pp. 419-423. https://doi.org/10.1038/sj.jhh.1001571
    Stirling, C. ; Houston, J. ; Robertson, S. ; Boyle, J. ; Allan, A. ; Norrie, John David ; Isles, C. G. / Diarrhoea, vomiting and ACE inhibitors: an important cause of acute renal failure. In: Journal of Human Hypertension. 2003 ; Vol. 17. pp. 419-423.
    @article{1da7ef04e7b540bb9bd0afcf1effa4d8,
    title = "Diarrhoea, vomiting and ACE inhibitors: an important cause of acute renal failure",
    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 mumol/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 greater than or equal to200 mumol/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) mumol/l before admission, 292 (216-724) mumol/l when first seen in hospital, and 134 (94-219) mumol/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.",
    keywords = "acute renal failure, ACE inhibitors, diarrhoea, vomiting, CONVERTING-ENZYME-INHIBITOR, LEFT-VENTRICULAR DYSFUNCTION, HEART-FAILURE, THERAPY, DISEASE",
    author = "C. Stirling and J. Houston and S. Robertson and J. Boyle and A. Allan and Norrie, {John David} and Isles, {C. G.}",
    year = "2003",
    doi = "10.1038/sj.jhh.1001571",
    language = "English",
    volume = "17",
    pages = "419--423",
    journal = "Journal of Human Hypertension",
    issn = "0950-9240",
    publisher = "Nature Publishing Group",

    }

    TY - JOUR

    T1 - Diarrhoea, vomiting and ACE inhibitors: an important cause of acute renal failure

    AU - Stirling, C.

    AU - Houston, J.

    AU - Robertson, S.

    AU - Boyle, J.

    AU - Allan, A.

    AU - Norrie, John David

    AU - Isles, C. G.

    PY - 2003

    Y1 - 2003

    N2 - 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 mumol/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 greater than or equal to200 mumol/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) mumol/l before admission, 292 (216-724) mumol/l when first seen in hospital, and 134 (94-219) mumol/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.

    AB - 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 mumol/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 greater than or equal to200 mumol/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) mumol/l before admission, 292 (216-724) mumol/l when first seen in hospital, and 134 (94-219) mumol/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.

    KW - acute renal failure

    KW - ACE inhibitors

    KW - diarrhoea

    KW - vomiting

    KW - CONVERTING-ENZYME-INHIBITOR

    KW - LEFT-VENTRICULAR DYSFUNCTION

    KW - HEART-FAILURE

    KW - THERAPY

    KW - DISEASE

    U2 - 10.1038/sj.jhh.1001571

    DO - 10.1038/sj.jhh.1001571

    M3 - Article

    VL - 17

    SP - 419

    EP - 423

    JO - Journal of Human Hypertension

    JF - Journal of Human Hypertension

    SN - 0950-9240

    ER -