The effect of aldosterone blockade in patients with Alport syndrome
The effect of aldosterone blockade in patients with Alport syndrome
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DOI：
10.1007/s00467-006-0270-8
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发表时间：
2006-12-01
影响因子：
3
通讯作者：
Matsuo, Masafumi
中科院分区：
文献类型：
--
作者：
Kaito, Hiroshi;Nozu, Kandai;Matsuo, Masafumi
最近的研究表明，在血管紧张素转换酶抑制剂（ACEI）或ACEI与血管紧张素受体阻断剂（ARB）中加入矿化皮质激素受体拮抗剂spironolactone (SP)，被称为三联阻断，可增强对慢性肾病患者尿蛋白排泄的更有益的作用。在这项研究中，我们探讨了SP对持续性蛋白尿Alport综合征患者尿蛋白排泄的影响，尽管长期使用ACEI（赖诺普利）或ACEI和ARB（坎地沙坦）。纳入5例Alport综合征患者，开始SP治疗（25mg /天）。开始给药时，所有患者肾功能良好，无高血压。我们决定通过测定晨尿蛋白/肌酐比值（U-P/C）和估计的肾小球滤过率（EGFR）来评估SP的作用。SP治疗开始后，U-P/C在3、6、12和18个月显著降低，而EGFR没有变化。收缩压和舒张压下降有统计学意义，血清钾水平略有升高。所有患者均未出现严重高钾血症（> 5.0 mEq/l）。这些结果表明，醛固酮受体阻断联合ACEI和ARB治疗对于减少Alport综合征患者和其他慢性肾脏疾病患者的蛋白尿提供了有价值的辅助治疗。因此，SP有望成为治疗Alport综合征的一种良好的肾保护剂。这些初步数据表明，应该对这种疗法进行大规模试验。
Recent studies indicate that adding the mineralocorticoid receptor antagonist spironolactone (SP) to angiotensin converting enzyme inhibitors (ACEI) or ACEI and angiotensin receptor blocker (ARB), which is known as a triple blockade, enhances the more beneficial effects on urinary protein excretion of patients with chronic kidney diseases. In this study, we explored the effects of SP on urinary protein excretion in patients with Alport syndrome featuring persistent proteinuria in spite of the long-term use of ACEI (lisinopril) or both ACEI and ARB (candesartan). Five patients with Alport syndrome were enrolled and SP treatment (25 mg/day) was started. At the start of SP administration, all patients showed good renal function and none of them suffered from hypertension. We decided to assess the effect of SP by determining the morning urinary protein/creatinine ratio (U-P/C) and estimated glomerular filtration rate (EGFR). After SP treatment was started, U-P/C was significantly reduced at 3, 6, 12 and 18 months, while EGFR did not change. The drop in systolic and diastolic blood pressure was statistically significant and serum potassium level was slightly elevated. None of the patients showed signs of severe hyperkalemia (> 5.0 mEq/l). These results suggest that aldosterone receptor blockade combined with ACEI and ARB therapy offers a valuable adjuvant treatment for the reduction of proteinuria in patients with Alport syndrome as in those with other chronic kidney diseases. SP can thus be expected to constitute a good renoprotective agent for Alport syndrome. These preliminary data indicate that large-scale trials of this therapy should be done.