Burns G C, Paul S K, Toth I R, Sivak S L
Department of Medicine, St. Vincent's Hospital and Medical Center, New York, New York, USA.
J Am Soc Nephrol. 1997 Jul;8(7):1140-6. doi: 10.1681/ASN.V871140.
Angiotensin-converting enzyme inhibition (ACEI) delays progression of diabetic and nondiabetic renal disease. This study examined the effect of fosinopril, 10 mg by mouth daily, in HIV-associated nephropathy (HIV-AN). Twenty patients with HIV-AN were studied. Of 11 patients with non-nephrotic-range proteinuria, 7 received treatment and 4 did not. Average baseline creatinine (mg/dl) for treated and nontreated patients was 1.3 +/- 0.24 and 1.0 +/- 0.25, respectively (P = 0.07). At 24 wk, creatinine of treated and nontreated patients was 1.5 +/- 0.34 and 4.9 +/- 2.4 (P = 0.006). Average baseline 24-h urine protein excretion (g/d) for treated and nontreated patients was 1.6 +/- 0.68 and 0.78 +/- 0.39, respectively (P = 0.02). At 24 wk, 24-h protein excretion of treated and non-treated patients was 1.25 +/- 0.86 and 8.5 +/- 1.4 (P = 0.006). Of nine patients with nephrotic-range proteinuria, five were treated and four were not. Average baseline creatinine for treated and nontreated patients was 1.7 +/- 0.46 and 1.9 +/- 0.42, respectively (P = 0.4). At 12 wk, creatinine for treated and nontreated patients was 2.0 +/- 1.0 and 9.2 +/- 2.0 (P = 0.02). The baseline 24-h protein excretion for treated and nontreated patients was 5.4 +/- 1.6 and 5.2 +/- 0.97 (P = 0.9). At 12 wk, 24-h protein excretion for treated and nontreated was 2.8 +/- 1.0 and 10.5 +/- 3.5 (P = 0.008). These preliminary data suggest that treatment with ACEI may stabilize serum creatinine and 24-h protein excretion for up to 24 wk in patients with non-nephrotic-range proteinuria and for up to 12 wk in patients with nephrotic-range proteinuria when initial serum creatinine is < or = 2.0 mg/dl. Furthermore, the renin-angiotensin system may play a role in HIV-AN, and early treatment with ACEI may be beneficial in HIV-AN.
血管紧张素转换酶抑制剂（ACEI）可延缓糖尿病和非糖尿病肾病的进展。本研究检测了每日口服10毫克福辛普利对HIV相关性肾病（HIV-AN）的影响。对20例HIV-AN患者进行了研究。在11例非肾病范围蛋白尿患者中，7例接受了治疗，4例未接受治疗。接受治疗和未接受治疗患者的平均基线肌酐水平（mg/dl）分别为1.3±0.24和1.0±0.25（P = 0.07）。在24周时，接受治疗和未接受治疗患者的肌酐水平分别为1.5±0.34和4.9±2.4（P = 0.006）。接受治疗和未接受治疗患者的平均基线24小时尿蛋白排泄量（g/d）分别为1.6±0.68和0.78±0.39（P = 0.02）。在24周时，接受治疗和未接受治疗患者的24小时蛋白排泄量分别为1.25±0.86和8.5±1.4（P = 0.006）。在9例肾病范围蛋白尿患者中，5例接受了治疗，4例未接受治疗。接受治疗和未接受治疗患者的平均基线肌酐水平分别为1.7±0.46和1.9±0.42（P = 0.4）。在12周时，接受治疗和未接受治疗患者的肌酐水平分别为2.0±1.0和9.2±2.0（P = 0.02）。接受治疗和未接受治疗患者的基线24小时蛋白排泄量分别为5.4±1.6和5.2±0.97（P = 0.9）。在12周时，接受治疗和未接受治疗患者的24小时蛋白排泄量分别为2.8±1.0和10.5±3.5（P = 0.008）。这些初步数据表明，对于初始血清肌酐≤2.0 mg/dl的非肾病范围蛋白尿患者，ACEI治疗可使血清肌酐和24小时蛋白排泄量稳定长达24周；对于肾病范围蛋白尿患者，可稳定长达12周。此外，肾素-血管紧张素系统可能在HIV-AN中起作用，早期使用ACEI治疗可能对HIV-AN有益。
