Studies on protection of progression of renal impairment.

在各种肾脏疾病中，饮食和血压是控制肾功能的重要因素。到目前为止，已经明确的是，适当限制盐和蛋白质对肾功能损害患者是有效的，但钙（Ca）补充是否对这些患者有用尚不清楚。此外，高血压对肾功能损害患者的危害程度仍存在争议。本研究通过动物实验和肾功能不全患者，研究了饮食和降压药对肾功能和血压的影响。在第一个用doca盐阿霉素治疗大鼠的动物实验中，口服钙补充剂通过磷酸盐结合作用改善了肾损伤的部分慢性进展。第二次动物实验采用5/6只去肾盐负荷自发性高血压大鼠，研究各种降压药物对肾功能和高血压的影响。本研究表明，血管紧张素转换酶（ACE）抑制剂和钙通道阻滞剂比利尿剂对肾脏损害和肾脏组织学改变的进展更有效。然而，ACE抑制剂和Ca通道阻滞剂之间没有显著差异，尽管Ca通道阻滞剂与ACE抑制剂没有不同的扩张性传出小动脉。在伴有肾损害的高血压患者中，两种钙通道阻滞剂被证明在控制高血压和肾功能方面是有效的。对于血清肌酐超过2 mg/dl的肾损害晚期患者，钙通道阻滞剂似乎比ACE抑制剂更安全。这些研究表明，在限制盐和蛋白质的基础上补充钙可以有效预防肾功能损害，钙通道阻滞剂也可以有效控制高血压和肾功能以及ACE抑制剂，尽管钙通道阻滞剂的作用机制应该与ACE抑制剂不同。少

Diet and blood pressure are important in the control of renal function in various renal diseases. Until now it has been made clear that appropriate restriction of salt and protein is effective in patients with renal impairment, but it is unknown that calcium(Ca) supplementation is useful for those patients. Furhtermore it is still controversial how much hypertension is harmful in pateints with renal impairment. In this study the effects of diet and antihypertensive drugs on renal function and blood pressure were studied in animal experiments and in patients with renal impairment.In the first animal experiment using DOCA-salt adriamycin treated rats, oral Ca supplementation ameliolated a part of chronic progression of renal damage by phosphate binding action. In the second animal experiment using 5/6 nephrectomized salt loaded spontaneously hypertensive rats, effects of various antihypertensive drugs on renal function and hypertension were studied. In this study it was demonstrated that … More an angiotensin converting enzyme(ACE) inhibitor and a Ca channel blocker are more effective than a diuretic to the progression of renal impairment and renal histological changes. However, there were no significact differences between the ACE inhibitor and the Ca channel blocker, although the Ca channel blocker didn't dilate the efferent arteriole different from the ACE inhibitor.In hypertensive patients with renal impairment 2 types of Ca channel blockers were demonstrated to be effective in the control of hypertension and renal function Ca channel blockers seemed to be safer than ACE inhibitors in patients with advance renal damage showing serum creatinine over 2 mg/dl.From these studies it was suggested that Ca supplementation in addition to salt and protein restriction is effective for prevention of renal impairment, and Ca channel blockers are also effective in the control of hypertension and renal function as well as ACE inhibitors, although the mechanims of action of Ca channel blockers were supposed to be different from that of ACE inhibitors. Less