RESPONSE TO THE FUROSEMIDE TEST MAY PREDICT THE EFFECTS OF DELAPRIL ON RENAL FUNCTION IN PATIENTS WITH CHRONIC RENAL INSUFFICIENCY

Abstract

Background : It is not clear whether the administration of an angiotensin- converting enzyme (ACE) inhibitor consisitently slows the progression of disease in patients with renal disease. We investigated the usefulness of the furosemide test in predicting the efficacy of delapril, an ACE inhibitor, in patients with chronic renal insuffi- clency. Methods : Delapril (7.5 mg to 15 mg) was administered daily to 24 patients with chronic renal insufficiency as indicated by a serum concentration of creatinine (Scr) between 1.2 mg/dl and 3.0 mg/dl. Patients were classified into improved, unchanged, and worsened groups based on the effect of delapril on the Scr. We measured the following parameters before the administration of delapril for a mean of 9 months blood pressure, Scr, urinary protein excretion, urinary sodium excretion, and changes in the renin and aldosterone response (the PRA ratio and PAC ratio) to a furosemide test. Results : Renal function was improved in 6 patients, unchanged in 8 patients, and worsend in 10 patients after delapril treatment. Urinary protein excretion was decreased, but not significantly, in all three groups. No significant differences in baseline parameters were observed among the groups before treatment. The PRA ratio was significantly higher in the group showing improvement vs. the groups showing either no improvement or a worsening of renal function. Conclusions : Delapril tended to reduce the urinary excretion of protein in patients with chronic renal insufficienty. However, delapril did not consistently reduce the rate of decline in glomerular filtration rate. The protective effect of this drug on renal function appeared to be related to the renin response to furosemide test.