Proteinürisi olan 3 farklı hasta grubunda hastaların anjiotensin dönüştürücü enzim inhibitörü ve/veya anjiotensin reseptör blokörü tedavilerinin karşılaştırılması

Year 2023, Volume: 14 Issue: 3, 633 - 638, 30.09.2023

Zeynep Melekoğlu Ellik , Burak Sayin

https://doi.org/10.18663/tjcl.1345274

Abstract

Amaç: Proteinürisi olan üç farklı hasta grubunda anjiyotensin dönüştürücü enzim (ACE) inhibitörleri ve anjiyotensin reseptör blokörlerinin etkinlik ve güvenliliğini değerlendirmek
Gereç ve Yöntemler: 24 saatlik idrarda 1 gramdan fazla proteinürisi olan diyabetik nefropati, glomerülonefrit ve böbrek transplantasyonu tanısı olan 168 hasta çalışmaya alındı. Hastalar 1. grup ACE inhibitörü kullananlar, 2. grup anjiyotensin reseptör blokörü (ARB) kullananlar ve 3. grup hem ACE inhibitörü hem de ARB kullananlar olarak üç gruba ayrıldı. Hastaların eşlik eden hastalıkları, kullandığı ilaçlar ve kan üre nitrojeni, kreatinin, potasyum, 24 saatlik idrar protein atılımı, kreatinin klirensini içeren laboratuvar değerleri 0-1-3-6-9-12-18-24.aylarda kaydedildi. Hastaların çalışma başlangıcı ve takibi sonunda ekokardiyografik değişiklikleri kaydedildi.
Bulgular: Her üç grupta da 0. aydaki proteinüri değerleri ile diğer tüm aylardaki proteinüri değerleri arasında istatistiksel olarak anlamlı bir düşüş gözlendi. Hem ACE inhibitörü hem de ARB'leri kullanan grup 3 hastalarda 9. aydan itibaren kreatinin seviyeleri anlamlı derecede yükseldi. Grup 1'deki ACE inhibitörü kullanan hastalarda takibin 9. ayından sonra kreatinin klirensi değerlerinde anlamlı bir azalma saptanırken, grup 3'teki ACE inhibitörü ve ARB kullanan hastaların 12. aydan sonra kreatinin klirensleri değerlerinde istatiksel olarak anlamlı bir düşüş saptandı. Grup 2'de ARB kullanan hastalarda kreatinin klirensinde anlamlı bir azalma görülmedi.
Sonuç:24 saatlik idrarda 1 g'dan yüksek proteinürisi olan hastalar ACEi veya ARB tedavileri almalı ve ACE inhibitörü ve anjiotensin reseptör blokörlerinin kombine tedavisi ise sadece yakından izlenebilecek seçilmiş hastalarda kullanılmalıdır.

Keywords

Proteinüri, ACEi, ARB, RAAS inhibitörleri

Supporting Institution

The study was approved by the ethics committee of Baskent University Medical Faculty (Date: 09/07/2015, Approval number: KA15/234).

Project Number

Approval number: KA15/234

Comparison of angiotensin converting enzyme ınhibitor and/or angiotensin receptor blocker treatments of patients in 3 different patient groups with proteinuria

Abstract

Aim: To evaluate the efficacy and safety of angiotensin-converting enzyme (ACE) inhibitors and angiotensin receptor blockers (ARBs) for proteinuria in three different patient groups with chronic kidney disease (CKD).
Material and Methods:168 patients with diabetic nephropathy, glomerulonephritis, and renal transplantation who had more than 1 gram of daily urinary protein excretion were enrolled. The patients were divided into three groups: group 1 users of ACE inhibitors, group 2 users of ARBs, and group 3 users of both ACE inhibitors and ARBs. The clinical and laboratory parameters recorded for the patients included comorbid diseases, medications, blood urea nitrogen, creatinine, potassium, 24-hour urinary protein excretion, and creatinine clearance. Laboratory tests were recorded for months 0-1-3-6-9-12-18-24. Echocardiographic changes were recorded for months 0 and 24.
Results: In all three groups, a statistically significant decrease was observed between the proteinuria levels at month 0 and all other months. Patients receiving ACE inhibitors and ARBs had significantly higher creatinine levels after the 9th month. The patients in group 1 showed a significant decrease in creatinine clearance after the 9th month of the study. In contrast, patients in group 3 showed a significant decline after the 12th month of the study. In group 2, patients using ARBs showed no significant decrease in creatinine clearance.
Conclusion: Patients with proteinuria greater than 1g per day should receive ACE inhibitors or ARB treatment, and combined therapy of ACE inhibitors and ARBs should only be used in selected patients who can be closely monitored.

Keywords

Proteinuria, ACE inhibitors, ARB, RAAS inhibitors

Project Number

Approval number: KA15/234

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