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Appropriateness of ordering serum angiotensin-converting enzyme during renin-angiotensin-aldosterone system inhibitor therapy

  • A. Betrains
    Affiliations
    Clinical Department of Internal Medicine, University Hospitals Leuven, Herestraat 49, 3000 Leuven, Belgium
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  • P. Vermeersch
    Affiliations
    Clinical Department of Laboratory Medicine, University Hospitals Leuven, Herestraat 49, 3000 Leuven, Belgium
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  • S. Vanderschueren
    Correspondence
    Corresponding author at: Department of General Internal Medicine, University Hospitals Leuven, Herestraat 49, B-3000 Leuven, Belgium.
    Affiliations
    Clinical Department of General Internal Medicine, University Hospitals Leuven Research Department of Microbiology and Immunology, Laboratory for Clinical Infectious and Inflammatory Disorders, KU Leuven, Herestraat 49, 3000 Leuven, Belgium
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Published:October 05, 2018DOI:https://doi.org/10.1016/j.ejim.2018.09.018
      Sarcoidosis is a multisystem inflammatory disease of unknown etiology that manifests as non-caseating granulomas, predominantly in the lungs and intrathoracic lymph nodes, but possibly affecting any organ. Sarcoidal granulomas produce angiotensin-converting enzyme, and measurement of serum angiotensin-converting enzyme (SACE) activity is frequently part of the diagnostic workup of sarcoidosis. However, the value of SACE levels in diagnosing sarcoidosis remains controversial, due to suboptimal test specificity and sensitivity. [
      • Ungprasert P.
      • Carmona E.M.
      • Crowson C.S.
      • Matteson E.L.
      Diagnostic utility of angiotensin-converting enzyme in sarcoidosis: A population-based study.
      ] It is well established that treatment with ACE inhibitors (ACEIs) reduces SACE levels, making the measurement of SACE activity during ACEI treatment unreliable. [
      • Roulston J.E.
      • MacGregor G.A.
      The measurement of angiotensin-converting enzyme in subjects receiving captopril.
      ,
      • Kamoun P.P.
      • Bardeta J.I.
      • Di Giulio S.
      • Grunfeld J.P.
      Measurements of angiotensin-converting enzyme in captopril treated patients.
      ,
      • Lieberman
      Effect of converting enzyme inhibitors on serum ACE test.
      ] Angiotensin II receptor blockers (ARBs) offer an alternative route to block the renin-angiotensin-aldosterone system (RAAS). The effect of ARBs on SACE levels is unknown. In a retrospective study, we investigated the influence of RAAS-inhibitor therapy (ACEIs and ARBs) on SACE measurement and the implications of this interaction in clinical practice.

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        Diagnostic utility of angiotensin-converting enzyme in sarcoidosis: A population-based study.
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