Reversible renal impairment induced by treatment with the angiotensin II receptor antagonist candesartan in a patient with bilateral renal artery stenosis

BACKGROUND: It is well established that ACE-inhibitors should be avoided in patients with renal artery stenosis. In recent years it has also been recommended that caution should be demonstrated when angiotensin II blockers are used in the same type of patients but the evidence is based only on few cases. RESULTS: We describe a case where use of the angiotensin II antagonist candesartan (Atacand) induced renal failure in a patient with bilateral renal artery stenosis. The course of the case is enlighted by results from sequential renography, selective renal vein catheterisation for measurement of renin, and angiographic findings. CONCLUSIONS: In patients with renal artery stenosis the angiotensin II antagonist candesartan should be avoided.

背景：目前已有定论，肾动脉狭窄（renal artery stenosis）患者应避免使用血管紧张素转换酶抑制剂（ACE-inhibitors）。近年来，针对此类患者，临床也推荐需谨慎使用血管紧张素II受体拮抗剂（angiotensin II blockers），但相关证据仅基于少量病例。
结果：本研究报道1例双侧肾动脉狭窄患者使用血管紧张素II受体拮抗剂坎地沙坦（Atacand）后诱发肾功能衰竭的病例。该病例的病程通过连续肾显像、用于肾素（renin）测定的选择性肾静脉导管术以及血管造影结果得到阐明。
结论：肾动脉狭窄患者应避免使用血管紧张素II受体拮抗剂坎地沙坦。