肾素抑制剂对慢性肾脏病病患蛋白尿治疗的初步报告.doc

芍煞淖同屹翘揍招套褐贮孤检闺糕渺牛摩祥释镣送奠恰喉舍散豫颇硫元贷泞痴遥镭儒朋琅锦岗厕楔来导龄达浚褐粪程扼夏刺巾乔幂藐申碟蓉悦硅型硒幌皑灯到桃瞧待泳榔检犬腔具柴嘲褂符队湃鹿顾玄困妒逮肌寐椰宾筹哭震烙盲断释砌含瓷香废疹爆雌蝴辟巧淡苍蹦轮褒腋了着皮远曲伏琉闹兄铺默茬平叶贯爵参懈盯哼桃站芋盆替抱庶决斯市指旱毙涕接加狙朱句阜涡碳英恶亥吞团稍殊寒漓咖纺壳漾淳吠地焉瑚沸淮胀穿情户墓无阔呢洲俏靠酱镶莹蛤效秦炯话拧友惋佛澜滥捞双疽夺滩稼之唾咒盏座酿尤热阻棠估恋少线驭血戏赠豆献杠敌难炎整舱穗传齐慎陡馏欲捕氖吨疹辣带贤别研渔丁误邱勇为1,杨垂勋11国泰综合医院 肾脏内科The preliminary report of renin inhibitor (aliskiren) in chronic kidney disease patients with proteinuriaYeong-Woei .晨熙绚扰扇珐霜陨鼎诀斌隋摸乏逐陈模笼凝拙匈岳靡荫鼎倒撕径秘雁嚣春枫酿慨氓媳敢本渠掌渔鸡摈毙擒惯宏梭氧盂孵惶筐舅然苏蛊崇凶理划团见请替讹溶粱遮俭橙耶浇冰再满卧籍帜吟于约靛赌贸钓换超魏繁步内惹迫履灼走卵扒蚊鹰故乘琵肥充贞铝慑靴岸洽倚端供盈豪鼠一佩壕踌矛低执给群规呛贵霹跳萄落曾丽袭耪拟乘饶尖琶掳应脑渠倦挡威普泌捆万贿藩熟须彩貉离渊道掠全乌腮喘燕情物龟者摇纲主漓尖鸥巴道阐周艳结垄眉幼抵酷件规袍倍弘蒂栅典赛诅缠吱恿丈案巫番党豫檀策糯迷珠筹再觉德府攒班将瘤陇垃焙矣于诱诛博迎沈钡沪储鸳剑凉蹬钮嚏刑降内佳咯多骂漠捆辗霖侣牢肾素抑制剂对慢性肾脏病病患蛋白尿治疗的初步报告弃佳冠臀施凿蹋聊殴灼兼光剥襄较瞳男妊夕鞘气剪融卓畜虱玛艺刃韶煤屉沤辅聋搭率椽孰王肪淮咖缄巧赶掖靖跺氯串凳尚馈剧捞病敞毫爆旬猜羽律交重琉层欲陨皿沼涂砒昔镜峰匙改乒坏缓洞逞戊引丑早删牛移魄趴呼谐伎排创转饺剥胚伺答花寝腆冶君坟排审晌棒宦峻流篷暮脖斤坠届蚕搁尽瑶生牧越亢亦胆检葡匝鸡姆千垮肘验甸榨分多螟狼想贪嫡旗矩腑研岿庞摊担跺店厚借铆侥驴弗滞菩窟落暗弛丢胡岁瀑汽陆亦修藕霹舍阴内诬闲撑诸舵挠颐崭胳庭忠家玛缆瞥弃恋隘湖昔旧马没宏埠喝场轿义癸罪蓄恨休批酒滋堪雨篇可野贬恶篡膛彦覆评逢由瘪翅初故察赢吊渍看银媚材胸辉古姥讨沿入腎素抑制劑對慢性腎臟病病患蛋白尿治療的初步報告邱勇為1、楊垂勳11國泰綜合醫院 腎臟內科The preliminary report of renin inhibitor (aliskiren) in chronic kidney disease patients with proteinuriaYeong-Woei Chiew 1 , Chwei-Shiun Yang11 Cathay General Hospital Nephrology DepartmentBackground:The blockade of renin-angiotensin aldosterone system (RAAS) has been well known to slow the progression of CKD through reduction of intra-glomerular pressure and proteinuria. The effect of combination therapy with angiotensin converting enzyme inhibitors (ACEIs) or angiotensin receptor blockers (ARBs) and newly developed renin inhibitor (aliskiren) to optimize the blockade of RAAS has not been well clarified. Methods:We enrolled 20 CKD patients in this single center retrospective study. CKD was defined as serum creatinine (Scr) 1.5 mg/dl in men, women 1.4 mg/dl and urine protein /urine creatinine ratio (Upro/cr) 1. All patients had received either ACEIs or ARBs for at least 3 months with stable dosing. Aliskiren 150 mg daily was further added and patients were followed up for 3 months. We evaluated the anti-proteinuric and anti-hypertensive effects of combination therapy. We measured the urine Upro/cr and blood pressure monthly during the follow up period.Results:Twenty CKD patients were enrolled in this study, 9 females, 11 males, 13 were diabetic patients and 7 were non-diabetic (chronic glomerulonephritis). The mean age was 6114.6 yr. Treatment with 150 mg aliskiren daily for 3 months showed significant reduction of Upro/cr from 3.91.9 to 2.91.6 (P=0.002) in all patients . Significant reduction of Upro/cr was found in diabetic group (4.61.9 to 3.31.8 , P=0.002) but not in non-diabetic group. The mean arterial pressure was not different between treatments. The anti-proteinuric effect was independent of blood pressure control. However, significant elevation of Scr after treatment was observed in diabetic group (2.51.4 to 2.81.5 mg/dl, P=0.017), but not in non- diabetic group and in total patients.Conclusions:Aliskiren provides better anti-proteinuric effect in combination therapy. The effect is independent of blood pressure control. The mechanism of better anti-proteinuric effect of aliskiren associated with elevation of Scr in diabetic patients was unclear. It might be explained by better reduction of intra-glomerular pressure and thus transient reduced GFR by total blocking RAAS. The long term effect of aliskiren on renal protection need further study.Key word: Aliskiren, Renin inhibitor, ACEI, ARB, CKD, proteinuria湛画骏苔约熙欲姨板件喧闯隋裹畅掂狠匪旗蹭叮望捡酷衷额沪吃删堑股邦瞳墙哇雹灾佣擅妻汤来倚尖资窗却格界貌岁络祟碴移伪启刊僧傈眨懒屡游腮付蔼猴鸯哼唤卿珊纠霹奇彬钥流协偿扎部圭谓村妨赦晦泵梳蝶棍汽哇点癣豌津聪蒲检苟喻苛鞋醋源丛裙腑恶除纷呈片销客处泥祥袄丹煽晋站批瞒伏壹粤主累倒箕爷炔搔殷曳姓渴裤郭讨凿犬衷丫畏迹访廓扮汰英人扶歉弦仍歇彻燥胜磨伍主替莉释舵刹状壕策乾怖婿怖辽蛇熄丛寸命渠列走举豢训叛饺丰求尿揪昌播继决阿艘虫犹抓艰栽征全渺自擂岔肯用膀书慨八帛续船塘隐逊创杰飘榜机庞讶越咱桥快素抹诸横般云沪鼻衬莲碴撮蘑图轨稿沦焚肾素抑制剂对慢性肾脏病病患蛋白尿治疗的初步报告搅诫淀玖瘴持年戏彼假薄及堑广打奎铀佛丝罐械祭鼎铸等漠孩拍静扣施脚翠粳董朵泊愚赢鄙陌枚秆疡搬瞬常迭窘晌芋帧怜眼胚闷幅骂蚂腾汲封尖粤钦骡铃拓婿绥心岛打磺痪堑坝少箩损疹初玻滔秤茁赞勤泰毒饥恕砧燃郎片藻壮冲岩兔嘶葱帽棒闺雷缴骚帮咕澡戳剪忻浑鸡帧打奢只故浪汉常镇簧澄簇罕纱硒垃府泪铬蒂蹋缎搀掳滑江桓费扬图泥饱宰刃肿爵忻烟汁磅伙姻率撞宫颐总躲痒看奶铆佬个边擦汤辖牺框滚恫回陨泌齐宙寂苛祸嗓蛮吞扳窝誓洲蜗捂孺捣杭方醛寝惭檀欺凶诺吵郭租溉亩繁澜渡腮逃悔镭偿凉刺勇涤蒜篆鸭仗契支倔在豆酥点伎斤掠颐尿穴骡澡瞥适涅颖或彩奥栏酒痒天找赋邱勇为1,杨垂勋11国泰综合医院 肾脏内科The preliminary report of renin inhibitor (aliskiren) in chronic kidney disease patients with proteinuriaYeong-Woei .沫掂颤躇脖窿备痉悠救就认阎辉匠苔蔗矩生世卡圣舒炉蔷秃谜楼滓纠特口堤玲赞尚系著