腎機能障害におけるAngiotensin-Converting Enzyme Inhibitor治療の予後 : 治療初期クレアチニン変化および血清カリウムと腎の長期予後との関連性

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Many patients with renal insufficiency have been treated with angiotensin-converting enzyme inhibitors (ACEI), although acute decrement of renal function in these patients sometimes occurs after starting treatment. Whether these initial changes on renal function with treatment relate to disease progression or prognosis in non-diabetic nephropathies is not clearly established. Fifty patients with renal impairment (aged 52.4±6.9 years) were enrolled in this study. Clinical and laboratory data (mean blood pressure; MBP, serum creatinine; S-Cr, potassium; S-K, urinary protein excretion; UP) were measured at every visit before and after 3 months starting with ACEI treatment, evaluating short-term effects, and monitored at the end of the follow-up period (51.5±9.7 months). Long-term effects of ACEI were evaluated by reciprocal S-Cr change with treatment and survival analysis (primary end point; time to doubling of S-Cr). At 3 months ACEI administration, S-Cr level had increased in 24 cases (Group I), although it had decreased in the others (Group D). The levels of reciprocal S-Cr change were improved with ACEI treatment in Group D (p<0.05). In the survival analysis, 2 patients in Group D reached the end point compared with 7 patients in Group I (p<0.05). In Group D, S-K level was relatively low before ACEI treatment and had increased after ACEI treatment. Multivariate analysis showed strong correlation between S-K and renal prognosis with ACEI treatment. These results suggest that short-term S-Cr decrease with ACEI treatment is related to better prognosis of renal disease. S-K may be a predictor of short-term S-Cr change and long-term prognosis of renal function with ACEI treatment.
東京女子医科大学の論文

腎機能障害におけるAngiotensin-Converting Enzyme Inhibitor治療の予後 : 治療初期クレアチニン変化および血清カリウムと腎の長期予後との関連性

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