Effects of ramipril and valsartan on proteinuria and renal function in patients with nondiabetic proteinuria [Učinci ramiprila i valsartana na proteinuriju i bibrežnu funkciju u bolesnika s nedijabetičkom proteinurijom]

Bilić, Marija and Munjas-Samarin, Radenka and Ljubanović, Danica and Horvatić, Ivica and Galešić, Krešimir (2011) Effects of ramipril and valsartan on proteinuria and renal function in patients with nondiabetic proteinuria [Učinci ramiprila i valsartana na proteinuriju i bibrežnu funkciju u bolesnika s nedijabetičkom proteinurijom]. Collegium Antropologicum, 35 (4). pp. 1061-1066. ISSN 0350-6134

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Abstract

The renin-angiotensin system is involved in the progression of chronic renal disease of both diabetic and nondiabetic origin. The angiotensin-converting enzyme inhibitors and angiotensin II receptor blockers have been demonstrated to reduce urinary protein excretion and attenuate the development of renal injury. This prospective, randomized, 12-month study assessed the effects of ramipril (N = 23) vs. valsartan (N = 22) vs. combination of ramipril and valsartan (N = 26) on proteinuria, renal function and metabolic profile in 71 patients with nondiabetic proteinuria with normal or slightly impaired renal function. Monotherapy with ramipril or valsartan and combination of these two drugs significantly reduced proteinuria, serum creatinine, cholesterol and triglycerides as well as systolic and diastolic arterial blood pressure. There was no significant difference among three study groups according to reduction of arterial blood pressure, serum cholesterol and triglycerides. At one year, a significant reduction in serum creatinine was recorded in all three study groups, whereas at 3 and 6 months a statistically significant reduction in serum creatinine was only observed in patients on combination therapy. In addition, at 3 months the reduction of proteinuria was significantly greater in patients on combination therapy than in those on either monotherapy. These results indicated the combination therapy with angiotensin-converting enzyme inhibitors and angiotensin II receptor blockers to be more efficacious than either monotherapy in reducing proteinuria and serum creatinine level in the first 3 (proteinuria and serum creatinine) or 6 (serum creatinine) months of treatment.

Abstract in Croatian

Reninsko-angiotenzinski sustav uključen je u progresiju i dijabetičke i nedijabetičke kronične bubrežne bolesti. Pokazalo se da inhibitori angiotenzin-konvertirajućeg enzima i blokatori receptora angiotenzina II smanjuju proteinuriju i usporavaju razvoj bubrežnog oštećenja. U ovom prospektivnom, randomiziranom, 12-mjesečnom istraživanju uspoređivani su učinci ramiprila (N=23 bolesnika), valsartana (N=22) i kombinacije ramiprila i valsartana (N=26) na proteinuriju, bubrežnu funkciju i metabolički profil u 71 bolesnika s nedijabetičkom proteinurijom s normalnom ili blago oštećenom bubrežnom funkcijom. Monoterapija ramiprilom i valsartanom i kombinacija ova dva lijeka značajno su smanjili proteinuriju, serumski kreatinin, kolesterol i trigliceride kao i sistolički i dijastolički krvni tlak. Nije bilo statistički značajne razlike između 3 skupine u smanjenju krvnog tlaka, serumskog kolesterola i triglicerida. Nakon 12 mjeseci, značajno smanjenje serumskog kreatinina zabilježeno je u sve tri skupine bolesnika, dok je nakon 3 i 6 mjeseci statistički značajno smanjenje serumskog kreatinina opaženo samo u skupini bolesnika na kombinacijskoj terapiji. Osim toga, nakon 3 mjeseca smanjenje proteinurije bilo je statistički značajno veće u skupini na kombinacijskoj terapiji, nego u skupinama bolesnika s monoterapijom ramiprilom i valsartanom. Ovi rezultati pokazuju da je kombinacijska terapija inhibitorom angiotenzin-konvertirajućeg enzima i blokatora receptora angiotenzina II učinkovitija od monoterapije u smanjenju proteinurije i serumskog kreatinina nakon 3 mjeseca i smanjenju serumskog kreatinina nakon 6 mjeseci liječenja.

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