Saine DR, Ahrens ER
Renal impairment associated with losartan
Ann Int Med
(Apr) 124:775 1996

Saine and Ahrens report a diabetic woman who developed oliguric renal
failure six weeks after starting the angiotensin II receptor
antagonist Losartan for hypertension. The patient had a past history
of Type II diabetes mellitus, diffuse atherosclerotic vascular
disease and a small right kidney. Renal function returned to
baseline levels after the drug was discontinued.
Comment: This case is the first report of oliguric
acute renal failure following treatment with Losartan. Pharmacological
interruption of the renin-angiotensin system by converting enzyme
inhibitors is well know to cause hemodynamic deterioration of
glomerular filtration in patients with ineffective circulating fluid
volume to the kidneys. These patients include those with congestive
heart failure, intravascular volume contraction, bilateral renal
artery stenosis, and diffuse microvascular disease. Because Losartan
has a similar functional effect on the renin-angiotensin system
through direct receptor blockade, it should be expected to cause
similar renal hemodynamic effects, including sudden decrease of
glomerular filtration. (George R. Aronoff, M.D., University of
Louisville, Kentucky)