Division of Nephrology, Saiseikai Central Hospital, Minato-ku, Tokyo, Japan.
Clin Exp Nephrol. 2009 Dec;13(6):663-6. doi: 10.1007/s10157-009-0213-3. Epub 2009 Jul 24.
A patient with chronic kidney disease (CKD) due to membranous nephropathy with daily urinary protein excretion exceeding 5 g did not respond well to dual therapy with an angiotensin converting enzyme inhibitor (ACE-I) and angiotensin II receptor blocker (ARB). Addition of the mineralocorticoid receptor blocker (MRB), spironolactone, led to moderate reduction in daily urinary protein excretion. However, spironolactone had to be inevitably discontinued due to gynecomastia. Replacement of spironolactone with the selective MRB, eplerenone, added to the preceding treatment with ACE-I and ARB, resulted in remarkable reduction of daily urinary protein excretion to less than 0.2 g. This case suggests that triple blockade of renin-angiotensin-aldosterone (RAA) system with ACE-I, ARB, and MRB could be useful for CKD patients with massive proteinuria.
一位患有因膜性肾病引起的慢性肾脏病（CKD）的患者，每日尿蛋白排泄量超过 5 克，对血管紧张素转换酶抑制剂（ACE-I）和血管紧张素 II 受体阻滞剂（ARB）的双重治疗反应不佳。加用盐皮质激素受体阻滞剂（MRB）螺内酯可使每日尿蛋白排泄量适度减少。然而，由于出现男性乳房发育，螺内酯不可避免地被停用。用选择性 MRB，依普利酮替代螺内酯，与 ACE-I 和 ARB 之前的治疗联合应用，使每日尿蛋白排泄量显著减少到 0.2 克以下。本病例提示，用 ACE-I、ARB 和 MRB 三重阻断肾素-血管紧张素-醛固酮（RAA）系统可能对大量蛋白尿的 CKD 患者有益。
