Tylicki Leszek, Renke Marcin, Rutkowski Przemysław, Rutkowski Bolesław, Lysiak-Szydłowska Wiesława
Department of Nephrology, Medical University of Gdańsk, 80-211 Gdańsk, Poland.
Med Sci Monit. 2005 Apr;11(4):PI31-7. Epub 2005 Mar 24.
Pharmacological blockade of the renin-angiotensin-aldosteron system ameliorates glomerular and tubulointerstitial damage. For optimal renoprotection, high doses of angiotensin II converting enzyme inhibitors and angiotensin II subtype 1 receptor antagonists are commonly recommended, but cannot always be administered. The aim of this study was to evaluate the effects of low-dose (25 mg) losartan on proteinuria and tubular injury extent.
MATERIAL/METHODS: This was an open, randomized, 12-month study on the effects of 25 mg of losartan (n=19) vs. 10 mg of enalapril (n=14) as a control on proteinuria, urinary excretion of N-acetyl-beta-D-glucosaminidase (NAG), and blood pressure in patients with primary glomerulonephritis. The second part of the study was an uncontrolled assessment of the renal effects of 50-mg administration of losartan.
There were no significant differences between the groups in the effects on proteinuria and NAG excretion. Losartan and enalapril reduced proteinuria by 32.8% (p<0.029) and 40.9% (p<0.021), respectively, but did not affect NAG excretion. The antiproteinuric effect of losartan, achieved without changes in blood pressure, was particularly evident in subjects with proteinuria >1.5 g/24 h and normal blood pressure. 50 mg of losartan caused a significant decrease in NAG excretion vs. the baseline (p<0.027).
25 mg of losartan and 10 mg of enalapril equally reduce proteinuria. The significant antiproteinuric effect of losartan was achieved despite no changes in blood pressure. There were no differences between the drugs regarding their influence on tubular injury extent. 50 mg of losartan seems to be the minimal dose to improve tubular status.
肾素 - 血管紧张素 - 醛固酮系统的药理学阻断可改善肾小球和肾小管间质损伤。为实现最佳肾脏保护，通常推荐使用高剂量的血管紧张素 II 转换酶抑制剂和血管紧张素 II 1 型受体拮抗剂，但并非总能使用。本研究的目的是评估低剂量（25 毫克）氯沙坦对蛋白尿和肾小管损伤程度的影响。
材料/方法：这是一项为期 12 个月的开放性随机研究，比较 25 毫克氯沙坦（n = 19）与 10 毫克依那普利（n = 14）作为对照对原发性肾小球肾炎患者蛋白尿、N - 乙酰 - β - D - 氨基葡萄糖苷酶（NAG）尿排泄量和血压的影响。研究的第二部分是对 50 毫克氯沙坦肾脏效应的非对照评估。
两组在对蛋白尿和 NAG 排泄的影响方面无显著差异。氯沙坦和依那普利分别使蛋白尿降低 32.8%（p < 0.029）和 40.9%（p < 0.021），但未影响 NAG 排泄。氯沙坦在不改变血压的情况下实现的抗蛋白尿作用，在蛋白尿>1.5 g/24 h 且血压正常的受试者中尤为明显。与基线相比，50 毫克氯沙坦使 NAG 排泄量显著降低（p < 0.027）。
25 毫克氯沙坦和 10 毫克依那普利降低蛋白尿的效果相同。氯沙坦在血压未改变的情况下实现了显著的抗蛋白尿作用。两种药物在对肾小管损伤程度的影响方面无差异。50 毫克氯沙坦似乎是改善肾小管状况的最小剂量。
