Traindl O, Falger S, Reading S, Banyai M, Liebisch B, Gisinger J, Templ E, Mayer G, Kovarik J
Department of Internal Medicine III, University of Vienna, Austria.
Transplantation. 1993 Jun;55(6):1309-13. doi: 10.1097/00007890-199306000-00019.
Renal transplantation is frequently accompanied by systemic hypertension. In the present study we evaluated the effect of 2.5 mg lisinopril in 12 hypertensive and proteinuric renal graft recipients with stable graft function over 3 months. Only patients with absence of renal artery stenosis, at least as judged by technetium-scan imaging, were included. Lisinopril was effective in lowering systemic blood pressure. Mean arterial pressure was unchanged despite reduction of concomitant antihypertensive medication. Mean serum creatinine was unchanged during the study (1.95 +/- 0.8 mg/dl in the pretreatment period vs. 1.77 +/- 0.76 mg/dl in the intervention period, n.s.). Glomerular filtration rate remained stable (62.75 +/- 21.96 vs. 60.17 +/- 18.27 ml/min/1.73 m2, n.s.) whereas renal plasma flow increased (224.75 +/- 91.66 vs. 244.92 +/- 94.13 ml/min/1.73m2, P < 0.01), leading to a drop in filtration fraction (31.4 +/- 12.4 vs. 26.8 +/- 8.6, n.s.). Renal vascular resistance was significantly reduced following angiotensin-converting enzyme (ACE) inhibitor therapy (26,447 +/- 14,574 vs. 23,425 +/- 12,430 dyne sec cm-5/1.73 m2, P < 0.01). Mean daily proteinuric decreased significantly (2.98 +/- 2.06 vs. 2.06 +/- 2.29 g, P < 0.01) whereas in a group of patients with comparable blood pressure but without ACE inhibitor therapy and similar degree of proteinuria, 24-hr proteinuria remained stable. No severe side effects were observed--in particular, mean serum potassium showed only a slight increase and no clinically significant hyperkalemic condition was observed. When lisinopril therapy was withdrawn after 3 months, blood pressure increased in all patients, requiring reinstitution of additional antihypertensive medication. Renal hemodynamic parameters and daily proteinuria returned to baseline values. We conclude that 2.5 mg lisinopril daily was safe and effective in this group of renal transplant recipients and showed a good antihypertensive as well as antiproteinuric effect.
肾移植常伴有系统性高血压。在本研究中，我们评估了2.5毫克赖诺普利对12名移植肾功能稳定超过3个月的高血压且蛋白尿的肾移植受者的影响。仅纳入经锝扫描成像判断至少无肾动脉狭窄的患者。赖诺普利可有效降低系统性血压。尽管减少了联合使用的抗高血压药物，但平均动脉压未发生变化。研究期间平均血清肌酐未改变（治疗前期为1.95±0.8毫克/分升，干预期为1.77±0.76毫克/分升，无显著差异）。肾小球滤过率保持稳定（62.75±21.96对60.17±18.27毫升/分钟/1.73平方米，无显著差异），而肾血浆流量增加（224.75±91.66对244.92±94.13毫升/分钟/1.73平方米，P<0.01），导致滤过分数下降（31.4±12.4对26.8±8.6，无显著差异）。血管紧张素转换酶（ACE）抑制剂治疗后肾血管阻力显著降低（26,447±14,574对23,425±12,430达因秒厘米-5/1.73平方米，P<0.01）。平均每日蛋白尿显著减少（2.98±2.06对2.06±2.29克，P<0.01），而在一组血压相当但未接受ACE抑制剂治疗且蛋白尿程度相似的患者中，24小时蛋白尿保持稳定。未观察到严重副作用——特别是，平均血清钾仅略有升高，未观察到具有临床意义的高钾血症情况。3个月后停用赖诺普利治疗时，所有患者血压均升高，需要重新使用额外的抗高血压药物。肾血流动力学参数和每日蛋白尿恢复至基线值。我们得出结论，每日2.5毫克赖诺普利在该组肾移植受者中安全有效，具有良好的降压和抗蛋白尿作用。
