Successful effect of triple blockade of renin-angiotensin-aldosterone system on massive proteinuria in a patient with chronic kidney disease
Successful effect of triple blockade of renin-angiotensin-aldosterone system on massive proteinuria in a patient with chronic kidney disease
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DOI：
10.1007/s10157-009-0213-3
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发表时间：
2009-12-01
影响因子：
2.3
通讯作者：
Hosoya, Tatsuo
中科院分区：
文献类型：
--
作者：
Kuriyama, Satoru;Sugano, Naoki;Hosoya, Tatsuo
1例膜性肾病所致慢性肾病（CKD）患者，每日尿蛋白排泄量超过5 g，对血管紧张素转换酶抑制剂（ACE-I）和血管紧张素II受体阻滞剂（ARB）双重治疗反应不佳。添加盐皮质激素受体阻滞剂（MRB），螺内酯，导致每日尿蛋白排泄中度减少。然而，由于男性乳房发育症，螺内酯不得不停用。用选择性MRB依普利酮替代螺内酯，加用ACE-I和ARB治疗，导致每日尿蛋白排泄量显著减少至小于0.2 g。本病例提示ACE-I、ARB和MRB三联阻断肾素-血管紧张素-醛固酮（RAA）系统可能对伴有大量蛋白尿的CKD患者有用。
A patient with chronic kidney disease (CKD) due to membranous nephropathy with daily urinary protein excretion exceeding 5 g did not respond well to dual therapy with an angiotensin converting enzyme inhibitor (ACE-I) and angiotensin II receptor blocker (ARB). Addition of the mineralocorticoid receptor blocker (MRB), spironolactone, led to moderate reduction in daily urinary protein excretion. However, spironolactone had to be inevitably discontinued due to gynecomastia. Replacement of spironolactone with the selective MRB, eplerenone, added to the preceding treatment with ACE-I and ARB, resulted in remarkable reduction of daily urinary protein excretion to less than 0.2 g. This case suggests that triple blockade of renin-angiotensin-aldosterone (RAA) system with ACE-I, ARB, and MRB could be useful for CKD patients with massive proteinuria.