Acute kidney injury induced by angiotensin-converting enzyme inhibitor in a kidney transplant recipient: a case report

Abstract Background: We described our medical records in details combined with some published literature, to discuss the suitable population and timing of Angiotensin-Converting Enzyme Inhibitor (ACEI) in kidney transplant recipients(KTRs), and summarize the diagnosis and treatment of acute kidney injury in KTRs caused by ACEI provides a reference for the more rational application of ACEI in kidney transplant recipients in the future. Case presentation: This study describes a rare case of acute kidney injury in a kidney transplant recipient with an ACEI. A 37-year-old man underwent a kidney allograft from a brain-dead donor 7 months ago. The operation was succeed, and the postoperative serum creatinine fluctuation was 200-300umol/L. One week before admission, the patient adjusted the antihypertensive drugs under the guidance of the doctor, and changed the nifedipine to the benazepril due to his poor blood pressure control. The next day after the change, he developed gastrointestinal symptoms dominated by nausea. On the sixth day after the change, his gastrointestinal symptoms were aggravated, the nausea, vomiting, and decreased urine output happened. The patient rushed to our hospital for seeking help. There were no obvious abnormality found when physical examination. Laboratory examination showed that creatinine grow to 859.13 umol/L. The transplanted kidney under ultrasound didn’t showe any abnormality. After screening his medical history, we considered that the acute kidney injury induced by ACEI benazepril might happen. After we stop the administration of benazepril, the serum creatinine gradually decreased to 241.20umol/L. This is the first report of acute kidney injury caused by ACEI in a KTR. Conclusion: In KTRs, non-early use of ACEI/ARB requires regular monitoring of serum creatinine levels. These drugs should not be administered once creatinine levels have risen.