THE ROLE OF ALDOSTERONE ANTAGONISM AGENTS IN DIABETIC KIDNEY DISEASE

被引:5
作者
Wombwell, Eric [1 ,2 ]
Naglich, Andrew [1 ]
机构
[1] Univ Missouri, Sch Pharm, Kansas City, MO 64110 USA
[2] Centerpoint Med Ctr, Independence, MO USA
关键词
Aldosterone; Diabetic kidney disease; Mineralcorticoid receptor antagonists;
D O I
10.1111/jorc.12085
中图分类号
R47 [护理学];
学科分类号
1011 ;
摘要
Background: Diabetic kidney disease is a common consequence of the development of diabetes. In the United Kingdom 1830% of chronic kidney disease cases and 44% of end-stage renal disease cases in the United States have been attributed to complications of diabetic kidney disease. Angiotensin blockade using angiotensin converting enzyme inhibitors or angiotensin receptor blockers is the standard for slowing the progression of diabetic kidney disease. Evidence suggests that aldosterone antagonism added to standard therapy may be beneficial. Aim of Review: This paper aims to explore the pathophysiological contribution of aldosterone in diabetic kidney disease and review available literature for aldosterone antagonism through mineralocorticoid receptor blockade. Methods: A comprehensive literature search was conducted. Results were analysed and summarised. Results: Nine trials evaluating a total of 535 patients with diabetic kidney disease were identified that evaluated the use of aldosterone antagonists for reducing the signs of diabetic kidney disease. All trials demonstrated a marked decrease in urinary protein excretion when compared to, or added to angiotensin converting enzyme inhibition or angiotensin receptor blockade. The most commonly reported side effect in all of the trials was hyperkalaemia, which occurred in 6.1% of all patients evaluated. Aldosterone antagonists were generally well tolerated in the evaluated patient populations. Conclusion: Aldosterone antagonism may represent a safe and effective complimentary therapy to the use of angiotensin converting enzyme inhibition, or angiotensin receptor blockade, for slowing the progression of diabetic kidney disease.
引用
收藏
页码:9 / 18
页数:10
相关论文
共 33 条
[11]   Addition of Angiotensin Receptor Blockade or Mineralocorticoid Antagonism to Maximal Angiotensin-Converting Enzyme Inhibition in Diabetic Nephropathy [J].
Mehdi, Uzma F. ;
Adams-Huet, Beverley ;
Raskin, Philip ;
Vega, Gloria L. ;
Toto, Robert D. .
JOURNAL OF THE AMERICAN SOCIETY OF NEPHROLOGY, 2009, 20 (12) :2641-2650
[12]  
Molitch ME, 2004, DIABETES CARE, V27, P1240, DOI 10.2337/diacare.27.5.1240-a
[13]   Endocrinological Aspects of Proteinuria and Podocytopathy in Diabetes: Role of the Aldosterone/Mineralocorticoid Receptor System [J].
Nagase, Miki ;
Fujita, Toshiro .
CURRENT DIABETES REVIEWS, 2011, 7 (01) :8-16
[14]   Activation of the aldosterone/mineralocorticoid receptor system in chronic kidney disease and metabolic syndrome [J].
Nagase, Miki .
CLINICAL AND EXPERIMENTAL NEPHROLOGY, 2010, 14 (04) :303-314
[15]  
NICE, 2008, CG66 TYP 2 DIAB FULL
[16]   Spironolactone diminishes urinary albumin excretion in patients with type 1 diabetes and microalbuminuria: a randomized placebo-controlled crossover study [J].
Nielsen, S. E. ;
Persson, F. ;
Frandsen, E. ;
Sugaya, T. ;
Hess, G. ;
Zdunek, D. ;
Shjoedt, K. J. ;
Parving, H-H. ;
Rossing, P. .
DIABETIC MEDICINE, 2012, 29 (08) :E184-E190
[17]   Spironolactone further reduces urinary albumin excretion and plasma b-type natriuretic peptide levles in hypertensive type II diabetes treated with angiotensin-converting enzyme inhibitor [J].
Ogawa, S ;
Takeuchi, K ;
Mori, T ;
Nako, K ;
Ito, S .
CLINICAL AND EXPERIMENTAL PHARMACOLOGY AND PHYSIOLOGY, 2006, 33 (5-6) :477-479
[18]   Dual blockade of aldosterone and angiotensin II additively suppresses TGF-β and NADPH oxidase in the hypertensive kidney [J].
Onozato, Maristela Lika ;
Tojo, Akihiro ;
Kobayashi, Naohiko ;
Goto, Atsuo ;
Matsuoka, Hiroaki ;
Fujita, Toshiro .
NEPHROLOGY DIALYSIS TRANSPLANTATION, 2007, 22 (05) :1314-1322
[19]   Cell biology of the glomerular podocyte [J].
Pavenstädt, H ;
Kriz, W ;
Kretzler, M .
PHYSIOLOGICAL REVIEWS, 2003, 83 (01) :253-307
[20]   Mechanisms of glomerulosclerosis in diabetic nephropathy [J].
Qian, Ying ;
Feldman, Eva ;
Pennathur, Subramanian ;
Kretzler, Matthias ;
Brosius, Frank C., III .
DIABETES, 2008, 57 (06) :1439-1445