Captopril 為一種 Angiotensin-converting enzyme inhibitors (ACEI),可用於治療高血壓、心衰竭及一些慢性腎臟疾病,對大部分的患者而言,它是相當安全的藥物,但是當腎絲球體過濾壓減少時,如:腹瀉或使用利尿劑造成的脫水、心衰竭造成成的血液灌流不足,就有可能造成急性腎衰竭(Acute renal failure, ARF)。ACEI 造成的ARF 通常為無症狀、非寡尿性的,停藥之後症狀就可完全緩解。本文報告一位 63 歲,男性患者,因出血性腦中風而住進本院加護病房,病患於確定為出血性腦中風後即以 mannitol 降腦壓,之後因病患血壓偏高為 207/144mmHg,而以 captopril (25 mg) 1# TID 降壓,患者入院當天之 Scr 為 1.1 mg/dL,使用captopril二天後測得之 Scr為 4.6 mg/dL,BUN 為85 mg/dL,而病患在服用captopril隔天尿量即明顯減少,為 840 ml/day。因懷疑為 captopril 所造成的急性腎衰竭,而於測得 Scr 值偏高後即停用該藥。停藥當天病患使用 furosemide 20 mg Q8H 以助排尿,當天即有 3300 ml 的尿量,之後因病患尿量達 8080 ml/day,進入利尿期而將利尿劑停用。病患停用 captopril 5 天後,Scr 回復為 2.4 mg/dL,BUN 為 69 mg/dL。
        本文案例為糖尿病腎病變患者,為 ACEI 造成急性腎衰竭的高危險群,有可能在合併使用高劑量 mannitol (20%, 100 ml Q4H)造成血液灌流減少,再使用 captopril立即發生無症狀,非寡尿性的急性腎衰竭。本案例疑似 captopril 造成急性腎衰竭之Naranjo’s 評估分數為 5 分,因病患由少尿現象進入利尿期的過程僅停用 captopril單一藥物,因此較懷疑為 captopril 造成之急性腎竭。

        Captopril is an angiotensin-converting enzyme inhibitors (ACEI), it is useful for hypertension, congestive heart failure (CHF) and chronic renal disease patients. It is safe to use for most of patients, but it may cause acute renal failure (ARF) for patients who have the decrease of glomerular infiltration pressure induced by diarrhea, diuretics or CHF.
        This is a case report of a 63 years old, male, DM nephropathy patient, who has suffered from hemrrohage stroke, treated in intensive care unit (ICU). Mannitol was used for decreasing cranial pressure, and captopril for hypertension (207/114 mmHg). The baseline serum creatinine (Scr) of this patient was 1.1 mg/dL, two days after treatment of captopril, his Scr elevated to 4.6 mg/dL, and BUN was 85 mg/dL. Urine output was obviously decreased one day after captopril administration. Captopril was discontinued immediately because acute renal failure was suspected induced by captopril. Furosemide was used to improve urine output. Patient’s Scr was return to 2.4 mg/dL after discontinuing captopril treatment and the use of furosemide. The Naranjo’s score of captopril induced ARF was 5. We suspected that a high dose of mannitol (100 ml Q4H) increased the risk of acute renal failure caused by captopril.