Captopril-induced reversible acute renal failure in an infant with coarctation of the aorta

Activation of the renin-angiotensin system has been implicated in the initiation of hypertension associated with coarctation of the aorta, with sodium and volume expansion playing a role in maintenance of the hypertension. Increase in total peripheral resistance induced by the stenosis itself also has received increasing attention in the etiology of coarctation and renal vascular hypertension.1-5 To date, angiotensin-converting enzyme (ACE) inhibitors have been used to lower acutely blood pressure in patients with coarctation, as well as in "paradoxical" postoperative treatment of hypertension.2,6 We recently cared for a small infant with hypertension due to coarctation of the aorta who developed acute renal insufficiency while receiving captopril.