HSS Journal ®

, Volume 7, Issue 2, pp 183–186 | Cite as

Acute Kidney Injury in the Setting of Knee Arthroplasty: A Case Report and Discussion Investigating Angiotensin-Converting Enzyme Inhibitors as the Culprit

  • Andrew J. RosenbaumEmail author
  • Jason A. Luciano
  • Robert Marburger
  • Eric Hume
Case Report


Total knee arthroplasty (TKA) has become the predominant treatment modality for severe degenerative joint disease. With recent advancements in surgical and anesthetic technique, patients with severe comorbidities are able to have this procedure; they would have been precluded from TKA only a matter of years ago. Although many studies have investigated risk factors and the causes of perioperative morbidity and mortality in the arthroplasty patient, few have linked risk factors with specific outcomes. We present a case report that illustrates the link between the use of angiotensin-converting enzyme inhibitors and the development of postoperative acute kidney injury. While this relationship has been extensively studied in cardiac and gastric bypass patient populations, it has never been examined in the setting of joint replacement.


total knee arthroplasty (TKA) acute kidney injury (AKI) angiotensin-converting enzyme inhibitor (ACE-I) 


  1. 1.
    Benedetto U, Sciarretta S, Roscitano A, et al. Preoperative Angiotensin-converting enzyme inhibitors and acute kidney injury after coronary artery bypass grafting. Ann Thorac Surg. 2008; 86(4): 1160–1165.CrossRefGoogle Scholar
  2. 2.
    Boldt J, Schindler E, Harter K, Gorlach G, Hempelmann G. Influence of intravenous administration of angiotensin-converting enzyme inhibitor enalaprilat on cardiovascular mediators in cardiac surgery patients. Anesth Analg. 1995; 80(3): 480–485.PubMedGoogle Scholar
  3. 3.
    Bullock DP, Sporer SM, Shirreffs TG, Jr. Comparison of simultaneous bilateral with unilateral total knee arthroplasty in terms of perioperative complications. J Bone Joint Surg Am. 2003; 85-A(10): 1981–1986.CrossRefGoogle Scholar
  4. 4.
    Chertow GM, Burdick E, Honour M, Bonventre JV, Bates DW. Acute kidney injury, mortality, length of stay, and costs in hospitalized patients. J Am Soc Nephrol. 2005; 16(11): 3365–33670.CrossRefGoogle Scholar
  5. 5.
    Cittanova ML, Zubicki A, Savu C, et al. The chronic inhibition of angiotensin-converting enzyme impairs postoperative renal function. Anesth Analg. 2001; 93(5): 1111–1115.CrossRefGoogle Scholar
  6. 6.
    Comfere T, Sprung J, Kumar MM, et al. Angiotensin system inhibitors in a general surgical population. Anesth Analg. 2005; 100(3): 636–644, table of contents.CrossRefGoogle Scholar
  7. 7.
    Gill GS, Mills D, Joshi AB. Mortality following primary total knee arthroplasty. J Bone Joint Surg Am. 2003; 85-A(3): 432–435.CrossRefGoogle Scholar
  8. 8.
    Kincaid EH, Ashburn DA, Hoyle JR, Reichert MG, Hammon JW, Kon ND. Does the combination of aprotinin and angiotensin-converting enzyme inhibitor cause renal failure after cardiac surgery? Ann Thorac Surg. 2005; 80(4): 1388–1393; discussion 1393.CrossRefGoogle Scholar
  9. 9.
    Lynch NM, Trousdale RT, Ilstrup DM. Complications after concomitant bilateral total knee arthroplasty in elderly patients. Mayo Clin Proc. 1997; 72(9): 799–805.CrossRefGoogle Scholar
  10. 10.
    Morrey BF, Adams RA, Ilstrup DM, Bryan RS. Complications and mortality associated with bilateral or unilateral total knee arthroplasty. J Bone Joint Surg Am. 1987; 69(4): 484–488.CrossRefGoogle Scholar
  11. 11.
    Pannu N, Nadim MK. An overview of drug-induced acute kidney injury. Crit Care Med. 2008; 36(4 Suppl): S216–S223.CrossRefGoogle Scholar
  12. 12.
    Parvizi J, Holiday AD, Ereth MH, Lewallen DG. The Frank Stinchfield Award. Sudden death during primary hip arthroplasty. Clin Orthop Relat Res. 1999; 369: 39–48.CrossRefGoogle Scholar
  13. 13.
    Parvizi J, Mui A, Purtill JJ, Sharkey PF, Hozack WJ, Rothman RH. Total joint arthroplasty: When do fatal or near-fatal complications occur? J Bone Joint Surg Am. 2007; 89(1): 27–32.PubMedGoogle Scholar
  14. 14.
    Parvizi J, Sullivan TA, Trousdale RT, Lewallen DG. Thirty-day mortality after total knee arthroplasty. J Bone Joint Surg Am. 2001; 83-A(8): 1157–1161.CrossRefGoogle Scholar
  15. 15.
    Prasad N, Padmanabhan V, Mullaji A. Blood loss in total knee arthroplasty: an analysis of risk factors. Int Orthop. 2007; 31(1): 39–44.CrossRefGoogle Scholar
  16. 16.
    Restrepo C, Parvizi J, Dietrich T, Einhorn TA. Safety of simultaneous bilateral total knee arthroplasty. A meta-analysis. J Bone Joint Surg Am. 2007; 89(6): 1220–1226.CrossRefGoogle Scholar
  17. 17.
    Ritter M, Mamlin LA, Melfi CA, Katz BP, Freund DA, Arthur DS. Outcome implications for the timing of bilateral total knee arthroplasties. Clin Orthop Relat Res. 1997; 345: 99–105.CrossRefGoogle Scholar
  18. 18.
    Sheth NP, Lonner JH. Gowned and gloved orthopaedics: introduction to common procedures. Edited. Philadelphia: Elsevier/Saunders; 2008:407.Google Scholar
  19. 19.
    Thadhani R, Pascual M, Bonventre JV. Acute renal failure. N Engl J Med. 1996; 334(22): 1448–1460.CrossRefGoogle Scholar
  20. 20.
    Thakar CV, Kharat V, Blanck S, Leonard AC. Acute kidney injury after gastric bypass surgery. Clin J Am Soc Nephrol. 2007; 2(3): 426–430.CrossRefGoogle Scholar
  21. 21.
    Thakar CV, Worley S, Arrigain S, Yared JP, Paganini EP. Influence of renal dysfunction on mortality after cardiac surgery: modifying effect of preoperative renal function. Kidney Int. 2005; 67(3): 1112–1119.CrossRefGoogle Scholar
  22. 22.
    Tierney LM, McPhee SJ, Papadakis MA. Current medical diagnosis & treatment, 2008. In: McGraw-Hill’s AccessMedicine. Edited. New York: Lange Medical Books/McGraw-Hill; 2008.Google Scholar
  23. 23.
    Uchino S, Kellum JA, Bellomo R, et al. Acute renal failure in critically ill patients: a multinational, multicenter study. JAMA. 2005; 294(7): 813–818.CrossRefGoogle Scholar

Copyright information

© Hospital for Special Surgery 2011

Authors and Affiliations

  • Andrew J. Rosenbaum
    • 1
    Email author
  • Jason A. Luciano
    • 2
  • Robert Marburger
    • 3
  • Eric Hume
    • 3
  1. 1.Albany Medical CenterAlbanyUSA
  2. 2.Division of Trauma and General SurgeryUniversity of Pittsburgh Medical CenterPittsburghUSA
  3. 3.Department of Orthopaedic SurgeryCooper University HospitalCamdenUSA

Personalised recommendations