Antifibrotic Effects of Aldosterone Receptor Blocker (Spironolactone) in Patients with Chronic Kidney Disease

被引:41
作者
Guney, Ibrahim [1 ]
Selcuk, N. Yilmaz [2 ]
Altintepe, Lutfullah [3 ]
Atalay, Huseyin [2 ]
Basarali, M. Kemal [2 ]
Buyukbas, Sadik [2 ]
机构
[1] Konya Res & Training Hosp, Dept Nephrol, Konya, Turkey
[2] Selcuk Univ, Meram Med Fac, Dept Nephrol, Konya, Turkey
[3] Meram Res & Training Hosp, Dept Nephrol, Konya, Turkey
关键词
TGF-beta; 1; chronic kidney disease; spironolactone; proteinuria; URINARY TRANSFORMING GROWTH-FACTOR-BETA-1; CONVERTING ENZYME-INHIBITOR; DUAL BLOCKADE; PROTEINURIA; SYSTEM; BETA; THERAPY; ESCAPE; IGA;
D O I
10.3109/08860220903150312
中图分类号
R5 [内科学]; R69 [泌尿科学(泌尿生殖系疾病)];
学科分类号
1002 ; 100201 ;
摘要
Aims. Proteinuria and transforming growth factor beta (TGF-beta) are parameters that can lead to glomerulosclerosis and tubulointerstitial fibrosis. All components of the renin-angiotensin-aldosterone system (RAAS) activate the TGF-beta. Aldosterone may not be inhibited with angiotensin-converting enzyme inhibitors (ACEIs) and/or angiotensin receptor blockers (ARBs) due to aldosterone escape. We aimed to evaluate the effect of spironolactone on parameters leading to fibrosis. Methods. This prospective study included 30 non-diabetic chronic kidney disease (CKD) patients treated with ACEIs and/or ARBs. The patients were divided into two groups that are similar in terms of demographic parameters. 25 mg of spironolactone was added to group 1 (n = 15) for six months, though it was not administered to group 2 (n = 15). Creatinine (U-Cr), protein (U-Prot), and TGF-beta 1 (U-TGF-beta 1) were measured in spot urine sample in the beginning of study and six months later. Results. Twenty-four patients completed the study. There were no significant changes in mean blood pressure, glomerular filtration rate, creatinine, albumin, and plasma aldosterone concentrations during the observation period in either group. U-Prot/U-Cr (mg/mg Cr) was reduced from 2.43 +/- 4.85 at baseline to 1.66 +/- 3.51 at sixth month (p = 0.003) in group 1. In addition, U-TGF-beta 1/U-Cr (ng/mg Cr) was also reduced from 22.50 +/- 6.65 at baseline to 17.78 +/- 10.94 at sixth month (p = 0.041) in the same group. U-TGF-beta 1/U-Cr and U-Prot/U-Cr ratios after the sixth month were not found significant compared with baseline values in group 2. Conclusion. Spironolactone reduced both proteinuria and urinary TGF-beta 1 excretion in CKD patients. We consider that spironolactone would be beneficial to prevent progression of renal fibrosis in CKD.
引用
收藏
页码:779 / 784
页数:6
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