Renal artery stenosis in heart failure

Abstract

Captopril, an oral angiotensin-converting enzyme inhibitor, has proven to be effective in the management of congestive heart failure (CHF). 1 Several trials have documented short- and long-term hemodynamic and clinical improvement with captopril therapy, including increased exercise tolerance. 2,3 However, captopril may fail to improve or be detrimental to renal function 4 in some patients, particularly if accompanied by marked decreases in systemic pressures. Recent reports have described captopril-induced renal insufficiency in patients with bilateral renal artery stenosis or unilateral stenosis in a solitary kidney 5 and in renal transplant recipients with hypertension. 6 Herein we describe certain findings in 6 of 89 patients with significant CHF seen in a 10-month period in whom a diagnosis of significant renal artery stenosis was made.