Antifibrotic Effects of Aldosterone Receptor Blocker (Spironolactone) in Patients with Chronic Kidney Disease
Antifibrotic Effects of Aldosterone Receptor Blocker (Spironolactone) in Patients with Chronic Kidney Disease
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DOI：
10.3109/08860220903150312
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发表时间：
2009-01-01
期刊：
影响因子：
3
通讯作者：
Buyukbas, Sadik
中科院分区：
文献类型：
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作者：
Guney, Ibrahim;Selcuk, N. Yilmaz;Buyukbas, Sadik
目标。蛋白尿和转化生长因子β（TGF-β）是可导致肾小球硬化和肾小管间质纤维化的参数。肾素-血管紧张素-醛固酮系统（RAAS）的所有组分都激活TGF-β。由于醛固酮逃逸，血管紧张素转换酶抑制剂（ACEIs）和/或血管紧张素受体阻滞剂（ARB）可能无法抑制醛固酮。我们的目的是评估螺内酯对导致纤维化的参数的影响。方法.这项前瞻性研究纳入了30例接受ACEI和/或ARB治疗的非糖尿病慢性肾病（CKD）患者。患者被分为两组，这两组在人口统计学参数方面相似。第1组（n = 15）加入25 mg螺内酯，持续6个月，而第2组（n = 15）不给予螺内酯。在研究开始时和6个月后，检测尿肌酐（U-Cr）、尿蛋白（U-Prot）和TGF-β 1（U-TGF-β 1）。结果24名患者完成了研究。在观察期间，两组的平均血压、肾小球滤过率、肌酐、白蛋白和血浆醛固酮浓度均无显著变化。第1组的U-Prot/U-Cr（mg/mg Cr）从基线时的2.43 +/- 4.85降至第6个月时的1.66 +/- 3.51（p = 0.003）。此外，在同一组中，U-TGF-β 1/U-Cr（ng/mg Cr）也从基线时的22.50 +/- 6.65降至第6个月时的17.78 +/- 10.94（p = 0.041）。第2组6个月后的U-TGF-β 1/U-Cr和U-Prot/U-Cr比值与基线值相比无显著性差异。结论螺内酯可减少CKD患者的蛋白尿和尿TGF-β 1排泄。我们认为，螺内酯将有利于防止慢性肾脏病肾纤维化的进展。
Aims. Proteinuria and transforming growth factor beta (TGF-beta) are parameters that can lead to glomerulosclerosis and tubulointerstitial fibrosis. All components of the renin-angiotensin-aldosterone system (RAAS) activate the TGF-beta. Aldosterone may not be inhibited with angiotensin-converting enzyme inhibitors (ACEIs) and/or angiotensin receptor blockers (ARBs) due to aldosterone escape. We aimed to evaluate the effect of spironolactone on parameters leading to fibrosis. Methods. This prospective study included 30 non-diabetic chronic kidney disease (CKD) patients treated with ACEIs and/or ARBs. The patients were divided into two groups that are similar in terms of demographic parameters. 25 mg of spironolactone was added to group 1 (n = 15) for six months, though it was not administered to group 2 (n = 15). Creatinine (U-Cr), protein (U-Prot), and TGF-beta 1 (U-TGF-beta 1) were measured in spot urine sample in the beginning of study and six months later. Results. Twenty-four patients completed the study. There were no significant changes in mean blood pressure, glomerular filtration rate, creatinine, albumin, and plasma aldosterone concentrations during the observation period in either group. U-Prot/U-Cr (mg/mg Cr) was reduced from 2.43 +/- 4.85 at baseline to 1.66 +/- 3.51 at sixth month (p = 0.003) in group 1. In addition, U-TGF-beta 1/U-Cr (ng/mg Cr) was also reduced from 22.50 +/- 6.65 at baseline to 17.78 +/- 10.94 at sixth month (p = 0.041) in the same group. U-TGF-beta 1/U-Cr and U-Prot/U-Cr ratios after the sixth month were not found significant compared with baseline values in group 2. Conclusion. Spironolactone reduced both proteinuria and urinary TGF-beta 1 excretion in CKD patients. We consider that spironolactone would be beneficial to prevent progression of renal fibrosis in CKD.