Effect of Dual Blockade of Renin-Angiotensin System on Proteinuria
DOI:
https://doi.org/10.3889/oamjms.2013.004Keywords:
dual blockade, renin-angiotensin system, angiotensin-converting enzyme inhibitor, angiotensin receptor blocker, proteinuria.Abstract
Aim: Aim of the study was the evaluation of the effect of dual blockade of the renin-angiotensin system (RAS) on proteinuria.
Material and Methods: Sixty patients, included in the study, were treated with angiotensin-converting enzyme inhibitor and angiotensin receptor blocker for a period of 3 months.
Results: The dual blockade of RAS resulted with decrease of proteinuria, a slight increase of serum creatinine and was not associated with a lowering of blood pressure.
Conclusion: Combined therapy with ACE-I and ARB results in a more complete blockade of the RAS than monotherapy. In proteinuric nephropathies it reduces significantly baseline proteinuria.
Downloads
Metrics
Plum Analytics Artifact Widget Block
References
Elliott WJ: Therapeutic trials comparing angiotensin converting enzyme inhibitors and angiotensin II receptor blockers. Curr Hypertens Rep. 2000; 2:402-411. DOI: https://doi.org/10.1007/s11906-000-0045-8
Izzo JL Jr, Weir MR. Angiotensin-converting enzyme inhibitors. J Clin Hypertens (Greenwich) 2011; 13:667. DOI: https://doi.org/10.1111/j.1751-7176.2011.00508.x
Taylor AA, Siragy H, Nesbitt S. Angiotensin receptor blockers: pharmacology, efficacy, and safety. J Clin Hypertens (Greenwich) 2011; 13:677. DOI: https://doi.org/10.1111/j.1751-7176.2011.00518.x
Hanevold CD. Acute renal failure during lisinopril and losartan therapy for proteinuria. Pharmacotherapy. 2006; 26:1348-1351. DOI: https://doi.org/10.1592/phco.26.9.1348
Brenner BM, Cooper ME, de Zeeuw D, et al: Effects of losartan on renal and cardiovascular outcomes in patients with type 2 diabetes and nephropathy. N Engl J Med. 2001; 345:861-869. DOI: https://doi.org/10.1056/NEJMoa011161
Lewis EJ, Hunsicker LG, Clarke WR, et al. Renoprotective effect of the angiotensin-receptor antagonist irbesartan in patients with nephropathy due to type 2 diabetes. N Engl J Med. 2001; 345:851-860. DOI: https://doi.org/10.1056/NEJMoa011303
Lewis EJ, Hunsicker LG, Bain RP, et al. The effect of angiotensinconverting-enzyme inhibition on diabetic nephropathy. The Collaborative Study Group. N Engl J Med. 1993; 329:1456-1462. DOI: https://doi.org/10.1056/NEJM199311113292004
Kunz R, Friedrich C, Wolbers M, Mann JF. Meta-analysis: effect of monotherapy and combination therapy with inhibitors of the renin angiotensin system on proteinuria in renal disease. Ann Intern Med. 2008; 148:30-48. DOI: https://doi.org/10.7326/0003-4819-148-1-200801010-00190
Keane WF, Brenner BM, de Zeeuw D, et al. The risk of developing end-stage renal disease in patients with type 2 diabetes and nephropathy: the RENAAL study. Kidney Int. 2003; 63:1499-1507. DOI: https://doi.org/10.1046/j.1523-1755.2003.00885.x
Andersen NH, Mogensen CE. Angiotensin-converting enzyme inhibitors and angiotensin II receptor blockers: evidence for and against the combination in the treatment of hypertension and proteinuria. Curr Hypertens Rep. 2002; 4:394-402. DOI: https://doi.org/10.1007/s11906-002-0070-x
Russo D, Pisani A, Balletta MM, et al. Additive antiproteinuric effect of converting-enzyme inhibitor and losartan in normotensive patients with IgA nephropathy. Am J Kidney Dis. 1999; 33:851-856. DOI: https://doi.org/10.1016/S0272-6386(99)70416-6
Russo D, Minutolo R, Pisani A, et al. Coadministration of losartan and enalapril exerts additive antiproteinuric effect in IgA nephropathy. Am J Kidney Dis. 2001; 38:18-25. DOI: https://doi.org/10.1053/ajkd.2001.25176
Reddan DN, Owen WF Jr. IgA nephropathy and inhibitors of the renin angiotensin system: is reduction in proteinuria adequate proof of efficacy? Am J Kidney Dis. 2001; 38:182-185. DOI: https://doi.org/10.1053/ajkd.2001.26330
Ruilope LM, Aldigier JC, Ponticelli C, et al. Safety of the combination of valsartan and benazepril in patients with chronic renal disease. European Group for the Investigation of Valsartan in Chronic Renal Disease. J Hypertens. 2000; 18:89-95. DOI: https://doi.org/10.1097/00004872-200018010-00013
Hollenberg NK, Fisher ND, Price DA. Pathways for angiotensin II generation in intact human tissue. Evidence from comparative pharmacological interruption of the renin system. Hypertension 2000; 32:387-392. DOI: https://doi.org/10.1161/01.HYP.32.3.387
McLaughlin K, Jardine AG. Angiotensin converting enzyme inhibitors and angiotensin receptor (AT1) antagonists: either or both for primary renal disease? Nephrol Dial Transplant. 1999; 14:25-28. DOI: https://doi.org/10.1093/ndt/14.1.25
Slagman MCJ, Waanders F, Hemmelder MH et al. Moderate dietary sodium restriction added to angiotensin converting enzyme inhibition compared with dual blockade in lowering proteinuria and blood pressure: Randomised controlled trial BMJ. 2011; 343:d4366 doi: 10.1136/bmj.d4366 DOI: https://doi.org/10.1136/bmj.d4366
Więcek A, Nieszporek T, Zarzecki M. Dual blocade of the renin–angiotensin–aldosterone: does it always slow the progression of kidney disease? Przew Lek 2010; 2:40-45.
Downloads
Published
How to Cite
Issue
Section
License
http://creativecommons.org/licenses/by-nc/4.0