Combination Treatment of Angiotensin-II Receptor Blocker and Angiotensin-Converting-Enzyme Inhibitor in Non-Diabetic Renal Disease on Effect of Reducing Proteinuria

BACKGROUND: The fact that angiotensin-converting enzyme inhibitors(ACEI) and angiotensin receptor blockers(ARB) antagonize the renin-angiotensin system at different levels suggests that these agents, already confirmed by clinical benefit in retarding the progression of chronic renal disease, may have additive effects that result in even greater renoprotection when used in combination. But many studies have failed to distinguish clearly between the additive intrinsic renoprotective effect. So we aimed to assess the efficacy and safety of combined treatment of ACEI and ARB, and monotherapy of each drug in patients with non-diabetic renal disease. METHODS: 266 patients who have non-diabetic renal disease comfirmed by renal biopsy in Ajou university hospital retrospectively reviewed. After reviewing, 83 patients who were followed up for 24 weeks more and prescribed ACEI only, ARB only, or a combination of both drugs are selected. The 83 patients were classified into 3 subgroups based on the kind of the drugs prescribed. We evaluated the changes of serum creatinine, the amount of proteinuria, the development of hyperkalemia and hypotension in the subgroups. RESULTS: Dry cough was recorded in 10 patients of ACEI group and 4 patients of combination group. Orthostatic hypotension was recorded in 1 patient of ACEI group, 1 patient of ARB group, and 1 patient of combination group. Angioedema was recorded in 1 patient of ARB group and 1 patient of combination group. In ACEI group, ARB group, and combination group, amount of proteinuria decreased to 52.6%, 76.7% and 52.5% of initial amount at 24 week after starting each drug. There were no statistical significancy among these groups. Each initial mean serum creatinine concentration of groups (1.30.6 mg/dl, 1.30.5 mg/dl , 1.30.3 mg/dl) statistically didn't increase significantlyat 24 week after starting each drug(1.40.8 mg/dl, 1.30.6 mg/dl , 1.40.4 mg/dl). CONCLUSIONS: Combination treatment safely retards progression of non-diabetic renal disease compared with monotherapy. However we failed to distinguish clearly the additive intrinsic renoprotective effect. Another intervention aimed at non-renin angiotensin system pathogenesis is needed to completely halt the progression of renal disease.

Author dc:creator

• 박, 인휘

Contributors dc:contributor

• 김, 흥수
• 대학원 의학과
• 103238

• 비당뇨병성 신병증
• 안지오텐신 전환 효소 언제제
• 안지오텐신 수용체 길항제
• on-diabetic renal disease
• angiotensin-II receptor blocker
• angiotensin-converting-enzyme inhibitor

Language dc:language

ko

Identifier

http://dcoll.ajou.ac.kr:9080/dcollection/jsp/common/DcLoOrgPer.jsp?sItemId=000000000447
000000000447

OAI identifier oai:identifier

oai:repository.ajou.ac.kr:201003/2335