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In Reply.—Levin and colleagues describe the reversal of dialysis-depend
(Continued on p 918.)
(Continued from p 916.) ent renal failure in a 59-year-old white woman after treatment with enalapril maleate. Although not stated, the patient is assumed to have scleroderma characterized by joint stiffness, sclerodactyly, and dysphagia; the latter evolved to renal failure associated with neurologic manifestations despite prior treatment, or as a result of treatment with prednisone and D-penicillamine. After discontinuation of D-penicillamine, captopril and nifedipine were added to the treatment regimen. Captopril incompletely controlled the hemodynamic response and enalopril maleate therapy was started. Oliguric, acute renal failure improved over the course of 3 months resulting in a creatinine clearance of approximately 0.25 mL/s (serum creatinine, 425 to 550 μmol/L).
This case report continues to underscore the utility of angiotensin-converting enzyme inhibitors in the management of accelerated hypertension and renal insufficiency in scleroderma and sclerodermalike disorders. However,
STRONGWATER SL, STOFF J. Control of Hypertension and Reversal of Renal Failure in Undifferentiated Connective Tissue Disease by Enalapril-Reply. Arch Intern Med. 1990;150(4):916–918. doi:10.1001/archinte.1990.00390160156045