Perrin Nina E S S, Jaremko Georg A, Berg Ulla B
Department of Clinical Science, Intervention and Technology, Division of Pediatrics, Karolinska Institutet, B57, Children's Hospital, Karolinska University Hospital, Huddinge, Stockholm, Sweden.
Pediatr Nephrol. 2008 Jun;23(6):947-54. doi: 10.1007/s00467-008-0745-x.
Our objective was to study the effects of candesartan on diabetic glomerulopathy in young normoalbuminuric and normotensive patients with type 1 diabetes in a double-blind, placebo-controlled trial. In 13 patients aged 24 years at baseline, we evaluated blood pressure, kidney biopsies and kidney function tests at baseline and after 5 years of treatment. Kidney biopsies were examined with light and electron microscopy, glomerular filtration rate and effective renal plasma flow determined with inulin and para-aminohippuric acid clearances. Two patients in the placebo group needed antihypertensive treatment because they developed microalbuminuria and/or hypertension, but no patient in the candesartan group did. A significant reduction in mesangial matrix volume and mesangial volume occurred in the candesartan group, although changes in morphological parameters were similar between groups. Office blood pressure was significantly lower in the candesartan group at follow-up than in the placebo group. Deterioration in morphological parameters observed in earlier studies of our patients did not become worse during treatment with candesartan or placebo. The effects of candesartan, with reduction in morphological parameters and lowering of blood pressure, might influence future treatment of glomerulopathy in type 1 diabetes patients.
我们的目标是在一项双盲、安慰剂对照试验中，研究坎地沙坦对年轻的正常白蛋白尿且血压正常的1型糖尿病患者糖尿病肾小球病变的影响。在13名基线年龄为24岁的患者中，我们在基线时以及治疗5年后评估了血压、肾活检和肾功能测试。肾活检采用光镜和电镜检查，用菊粉和对氨基马尿酸清除率测定肾小球滤过率和有效肾血浆流量。安慰剂组有2名患者因出现微量白蛋白尿和/或高血压而需要抗高血压治疗，但坎地沙坦组没有患者需要此类治疗。坎地沙坦组的系膜基质体积和系膜体积显著减少，尽管两组间形态学参数的变化相似。随访时，坎地沙坦组的诊室血压显著低于安慰剂组。在我们患者的早期研究中观察到的形态学参数恶化在使用坎地沙坦或安慰剂治疗期间并未加重。坎地沙坦具有降低形态学参数和血压的作用，可能会影响未来1型糖尿病患者肾小球病变的治疗。
