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Effect of losartan on the recoverability of renal function in anuric and oliguric patients with a solitary obstructed kidney: a double‐blind randomized placebo‐controlled trial
Author(s) -
Elkappany Sherif,
Hashem Abdelwahab,
Elkarta Ahmed,
Sheashaa Hussein,
Osman Yasser,
Shokeir Ahmed A.
Publication year - 2020
Publication title -
bju international
Language(s) - English
Resource type - Journals
SCImago Journal Rank - 1.773
H-Index - 148
eISSN - 1464-410X
pISSN - 1464-4096
DOI - 10.1111/bju.15168
Subject(s) - medicine , renal function , urology , placebo , losartan , anuria , randomized controlled trial , creatinine , oliguria , anesthesia , surgery , angiotensin ii , blood pressure , alternative medicine , pathology
Objectives To assess the role of the angiotensin receptor blocker losartan on the recoverability of renal function after de‐obstruction in patients with anuria and oliguria. Materials and Methods This was a double‐blind randomized placebo‐controlled trial in anuric or oliguric patients with calcular obstruction of solitary kidney. Patients with an anomalous kidney or those with an American Society of Anesthesiology score of >3 were excluded. After relief of obstruction, patients were allocated to receive either losartan potassium 25 mg or placebo for 3 months. Serum creatinine (sCr) and renographic glomerular filtration rate (GFR) were measured at nadir and after 3 months. Changes in sCr and renographic GFR were calculated by subtracting the values at nadir from those at 3 months. Improvement, stabilization or deterioration of sCr and renographic GFR were defined as percentage increase or decrease from nadir ≥10%, while changes <10% were considered as stabilization. Results A total of 76 patients completed 3 months of follow‐up. Demographics and peri‐operative data were comparable in the two groups. The median (range) sCr change was −1.05 (−1.8, 0.4) and −0.5 (−1.3, 0.1) mg/dL in the losartan and placebo, groups, respectively ( P = 0.07). In the losartan group, renographic GFR had improved in 26 (59.1%) and deteriorated in six (13.6%) patients, while, in the placebo group, it had improved in eight (25%) and deteriorated in 10 patients (31.3%; P = 0.01). Losartan also enhanced renographic GFR improvement vs placebo by a median (range) of 6.9 (−9, 44) vs 1.4 (−10, 32) mL/min ( P = 0.004). Conclusions In patients with anuria and oliguria, losartan treatment contributes to renal function recoverability after relief of calcular obstruction of the solitary kidney.