Anarat A, Noyan A, Gonlusen G, Duman N, Tuncer D
Department of Pediatric Nephrology, Cukurova University School of Medicine, Adana, Turkey.
Pediatr Nephrol. 1996 Oct;10(5):616-20. doi: 10.1007/s004670050173.
The purpose of this study was to investigate if enalapril could be administered with cyclosporin A (CyA) to reduce its nephrotoxicity. Sixty rats were divided into five groups: group I, Control group; group II, rat treated with oral enalapril; group III, rats treated with CyA: group IV, rats treated with CyA and enalapril; group V, rats treated with enalapril before the CyA therapy. At the end of the therapy mean serum creatinine concentrations were not statistically different between the groups (P > 0.05), in groups treated with CyA there were no statistically significant differences between mean CyA levels (P > 0.05), and mean blood urea nitrogen levels of the groups treated with CyA were significantly elevated (P < 0.05) compared with groups not treated with CyA. Morphologically acute CyA nephrotoxicity was evaluated by the following features: (1) tubular vacuolization, (2) tubular necrosis, (3) tubular microcalcification, and (4) peritubular capillary congestion. These lesions were scored semiquantitatively on a scale from 0 to 4+. The most common tubular pathology was tubular vacuolization, which was more severe in groups III and IV. Tubular necrosis was most severe in group III. In conclusion, enalapril seems to suppress the severest form of CyA nephrotoxicity, namely tubular necrosis, if administered prior to CyA treatment.
本研究的目的是调查依那普利是否可与环孢素A（CyA）联合使用以降低其肾毒性。60只大鼠被分为五组：第一组为对照组；第二组为口服依那普利治疗的大鼠；第三组为接受CyA治疗的大鼠；第四组为接受CyA和依那普利治疗的大鼠；第五组为在CyA治疗前接受依那普利治疗的大鼠。治疗结束时，各组间平均血清肌酐浓度无统计学差异（P>0.05），接受CyA治疗的组间平均CyA水平无统计学显著差异（P>0.05），与未接受CyA治疗的组相比，接受CyA治疗的组平均血尿素氮水平显著升高（P<0.05）。通过以下特征对急性CyA肾毒性进行形态学评估：（1）肾小管空泡化，（2）肾小管坏死，（3）肾小管微钙化，（4）肾小管周围毛细血管充血。这些病变按0至4+进行半定量评分。最常见的肾小管病理改变是肾小管空泡化，在第三组和第四组中更为严重。肾小管坏死在第三组中最为严重。总之，如果在CyA治疗前给予依那普利，依那普利似乎可以抑制CyA肾毒性最严重的形式，即肾小管坏死。
