open access

Vol 10, No 6 (2006)
Prace oryginalne
Published online: 2007-01-11
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The effect of the triple renin-angiotensin-aldosterone system blockade on urinary protein excretion in patients with non-diabetic chronic nephropathy

Ewa Smoleń, Michał Nowicki
Nadciśnienie tętnicze 2006;10(6):501-510.

open access

Vol 10, No 6 (2006)
Prace oryginalne
Published online: 2007-01-11

Abstract


Background Many patients chronically treated with angiotensin-converting enzyme inhibitors or angiotensin receptor blockers show a slow but a steady return of plasma aldosterone levels to baseline values, i.e. “aldosterone escape” an effect which could interfere with both their antihypertensive and target organ protective efficacy. To avoid this effect aldosterone antagonist could be added and such combined therapy has already been found to be effective and safe in patients with diabetic nephropathy. There is however a paucity of data on the effectiveness and safety of a triple blockade of the renin-angiotensin-aldosterone system.
Material and methods 10 patients with non-diabetic chronic nephropathy with sub-nephrotic range of proteinuria treated with an converting enzyme inhibitor received in addition losartan (50 mg daily) for 6 weeks and for another 6 weeks both losartan and spironolactone (25 mg daily). Blood pressure, urine protein and creatinine, plasma sodium, potassium, creatinine, renin and aldosterone concentrations were measured at all stages of the study.
Results There was a trend for the blood pressure and proteinuria to decrease after the addition of both losartan and spironolactone and there was a significant decrease of these both parameters when the triple therapy was compared to an converting enzyme inhibitor alone. The decrease of blood pressure and proteinuria after losartan was tightly correlated but the same relation was not observed after spironolactone was added.
Conclusions Treatment with triple blockade of RAAS in patients with persistent, non-nephrotic proteinuria decreases protein excretion significantly. This renoprotective effect seems to be depended on a reduction of blood pressure.

Abstract


Background Many patients chronically treated with angiotensin-converting enzyme inhibitors or angiotensin receptor blockers show a slow but a steady return of plasma aldosterone levels to baseline values, i.e. “aldosterone escape” an effect which could interfere with both their antihypertensive and target organ protective efficacy. To avoid this effect aldosterone antagonist could be added and such combined therapy has already been found to be effective and safe in patients with diabetic nephropathy. There is however a paucity of data on the effectiveness and safety of a triple blockade of the renin-angiotensin-aldosterone system.
Material and methods 10 patients with non-diabetic chronic nephropathy with sub-nephrotic range of proteinuria treated with an converting enzyme inhibitor received in addition losartan (50 mg daily) for 6 weeks and for another 6 weeks both losartan and spironolactone (25 mg daily). Blood pressure, urine protein and creatinine, plasma sodium, potassium, creatinine, renin and aldosterone concentrations were measured at all stages of the study.
Results There was a trend for the blood pressure and proteinuria to decrease after the addition of both losartan and spironolactone and there was a significant decrease of these both parameters when the triple therapy was compared to an converting enzyme inhibitor alone. The decrease of blood pressure and proteinuria after losartan was tightly correlated but the same relation was not observed after spironolactone was added.
Conclusions Treatment with triple blockade of RAAS in patients with persistent, non-nephrotic proteinuria decreases protein excretion significantly. This renoprotective effect seems to be depended on a reduction of blood pressure.
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Keywords

renin-angiotensin-aldosterone system; converting enzyme inhibitors; aldosterone antagonists; angiotensin-receptor blockers; proteinuria; chronic nephropathy

About this article
Title

The effect of the triple renin-angiotensin-aldosterone system blockade on urinary protein excretion in patients with non-diabetic chronic nephropathy

Journal

Arterial Hypertension

Issue

Vol 10, No 6 (2006)

Pages

501-510

Published online

2007-01-11

Bibliographic record

Nadciśnienie tętnicze 2006;10(6):501-510.

Keywords

renin-angiotensin-aldosterone system
converting enzyme inhibitors
aldosterone antagonists
angiotensin-receptor blockers
proteinuria
chronic nephropathy

Authors

Ewa Smoleń
Michał Nowicki

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