Elizabeth asked
How big is the risk of kidney damage or failure with lisinopril?
Answer
Treatment with all ACE-Inhibitors, such as Zestril (lisinopril), are associated with a small risk of kidney dysfunction or rarely, acute renal failure. However, most, if not all adverse changes to kidney function are reversible upon discontinuation of the drug.
Most commonly, minor increases in blood urea nitrogen (BUN) and serum creatinine are seen but are again, reversible upon discontinuation of therapy. These kidney function changes are seen in about 2% of patients treated with lisinopril alone for high blood pressure according to the prescribing information. BUN and creatinine increases are more common (~11.6%) in patients those also taking diuretics.
In one clinical trial, the GISSI-3 trial, lisinopril-treated patients had an incidence of renal dysfunction of 2.4%, which led to stopping the medication in 2% of patients. In the elderly, discontinuation due to renal dysfunction was increased to 4.2%.
In another clinical trial, the ATLAS trial, similar results were seen, with elevated creatinine and blood urea nitrogren levels being seen in lisinopril treated patients. However, as discussed above, these increases were reversible upon discontinuation of therapy.
It is important to note that the risk of kidney dysfunction while taking lisinopril is higher in susceptible individuals, which include those with:
- Congestive heart failure
- Renal artery stenosis
- Chronic kidney disease
- Post-myocardial infarction (heart attack)
Lastly, the potential side effects that affect the kidney and urogenital system include:
- Acute renal failure
- Oliguria (low production of urine)
- Anuria (failure to product urine)
- Uremia (increased levels of urea)
- Azotemia (increased nitrogen waste in urine)
- Renal dysfunction
- Dysuria (painful urination)
Dosing of lisinopril is dependent on kidney function. If you have decreased kidney function, as measured by creatinine clearance, your dose of lisinopril will be adjusted.
