Diuretic and enhanced sodium restriction results in improved antiproteinuric response to RAS blocking agents
Diuretic and enhanced sodium restriction results in improved antiproteinuric response to RAS blocking agents
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DOI：
10.1681/asn.2004060505
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发表时间：
2005-02-01
影响因子：
13.6
通讯作者：
Nguyen, JM
中科院分区：
文献类型：
--
作者：
Esnault, VLM;Ekhlas, A;Nguyen, JM
血管紧张素转换酶抑制剂、血管紧张素受体阻滞剂和利尿剂可发挥协同抗蛋白尿作用。18例服用雷米普利5 mg/d治疗6个月后蛋白尿> 1g/24 h的患者随机分为雷米普利10 mg/d组、缬沙坦160 mg/d组或雷米普利5 mg/d+缬沙坦80 mg/d组。治疗期持续4周，间隔4周，用雷米普利5 mg/d洗脱。在这个交叉序列结束时，患者接受联合雷米普利5 mg/d，缬沙坦80 mg/d，并增加呋塞米剂量额外4周。主要终点是每个治疗期结束时两次24小时尿液采集的尿蛋白/肌酐比值。雷米普利10、缬沙坦160和雷米普利5和缬沙坦80联合治疗组的研究终点之间没有显著差异。然而，与缬沙坦160和雷米普利5与缬沙坦80联合给药相比，雷米普利5与缬沙坦80联合给药-增加呋塞米剂量的尿蛋白/肌酐比值较低，与雷米普利10相比趋势相似。与其他三种治疗相比，雷米普利5和缬沙坦80联合治疗增加呋塞米剂量可降低收缩压和升高血清肌酐，但没有显著增加症状性低血压病例的数量。因此，在重度蛋白尿和高血压患者中，除联合使用血管紧张素转换酶抑制剂和血管紧张素受体阻滞剂外，谨慎增加利尿剂剂量可降低蛋白尿和血压，但可能使患者暴露于肾前性衰竭。
Angiotensin-converting enzyme inhibitors, angiotensin receptor blockers, and diuretics may exert synergistic antiproteinuric effects. Eighteen patients with a proteinuria >1 g/24 h after 6 mo of treatment with ramipril at 5 mg/d were assigned to receive in random order ramipril at 10 mg/d, valsartan at 160 mg/d, or combined ramipril at 5 mg/d and valsartan at 80 mg/d in addition to their antihypertensive treatment. The treatment periods lasted 4 wk and were separated by a 4-wk washout with ramipril at 5 mg/d. At the end of this crossover sequence, patients received combined ramipril at 5 mg/d, valsartan at 80 mg/d, and an increased furosemide dosage for an additional 4-wk period. The primary end point was the urinary protein/creatinine ratio for two 24-h urine collections at the end of each treatment period. No significant differences were noted between the study end points of the ramipril 10, valsartan 160, and combined ramipril 5 and valsartan 80 treatment groups. However, the urinary protein/creatinine ratio was lower with combined ramipril 5 and valsartan 80-increased furosemide dosage than with valsartan 160 and combined ramipril 5 and valsartan 80, with a similar tendency compared with ramipril 10. Combined ramipril 5 and valsartan 80-increased furosemide dosage decreased systolic home BP and increased serum creatinine but did not significantly increase the number of symptomatic hypotension cases compared with the other three treatments. Thus, in patients with severe proteinuria and hypertension, a cautious increase in diuretic dosage in addition to combined angiotensin-converting enzyme inhibitors and angiotensin receptor blockers decreases proteinuria and BP but may expose the patient to prerenal failure.