Mikroalbuminürisi olan diyabetik ve esansiyel hipertansif hastalarda farklı antihipertansiflerin mikroalbuminüri üzerine etkilerinin retrospektif incelenmesi
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Tarih
2010
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Trakya Üniversitesi Tıp Fakültesi
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info:eu-repo/semantics/openAccess
Özet
Anjiotensin dönüştürücü enzim inhibitörlerinin, Anjiotensin reseptör antagonistleri ve non-dihidropiridin kalsiyum kanal antagonistlerinin mikroalbuminüriyi gerilettiği farklı çalışmalarda ileri sürülmektedir. Biz çalışmamızda Diyabetik nefropati ve hipertansif nefroskleroza bağlı proteinürisi olan hastalarda, Anjiotensin dönüştürücü enzim inhibitörleri ve Anjiotensin reseptör antagonistlerinin proteinürinin geriletilmesi ve böbrek fonksiyonlarının korunması üzerine olan etkilerini inceledik. Çalışmamızda diyabet ve hipertansiyon nedeni ile 1987-2009 tarihleri arasında Endokrinoloji polikliniğimize başvuran hipertansif ve diyabetik hasta dosyaları retrospektif olarak tarandı. Mikroalbuminürisi ve proteinürisi olan 88 hasta değerlendirmeye alındı. Hastalar bazal değeri olanlar ve olmayanlar olarak iki gruba ayrıldı. Verilerimizin değerlendirlmesi sonucunda; diyastolik kan basıncı ve sistolik kan basıncı arttıkça glomerül filtrasyon hızınn de arttığı görüldü. Vücut kitle indeksi arttıkça mikroalbuminüri de artmaktaydı. Bazal değeri olan grupta Anjiotensin dönüştürücü enzim inhibitörleri başlananlarda mikroalbuminüri anlamlı olarak düşük bulundu. Bazal değeri olan grubumuzu; renin anjiotensin aldesteron inhibisyonu yapılan tek grup olarak aldığımızda (n=33); tedavi sonrası mikroalbuminürinin anlamlı düzeyde azaldığını gördük. Sonuç olarak bu retrospektif çalışmada, ACEI ve ARB tedavisiyle proteinürinin gerilediğini ve bu gerilemenin ACEI grubunda daha belirgin olduğunu gözlemledik. Renin anjiyotensin sistemini bloke eden ilaçlar, yani ACEI ve ARB'ler tip 2 DM ve hipertansiyonu olan hastalarda mikroalbuminüri gelişimini ve nefropatinin ilerlemesini önlemek üzere kullanılmalıdır. Sonuçlarımıza göre de seçilecek ilk ajanın ACEI, ardından ARB olması gerektiğini düşünüyoruz.
Abstract
It has been suggested in various trials that angıotensin converting enzyme inhibitors, angiotensin receptor antagonists and nondihydropyridin calcium channel antagonist impede the progress of microalbuminuria. We evaluated the effects of angıotensin converting enzyme inhibitors and angiotensin receptor antagonists on renal functions and on impeding the progress of microalbuminuria in patients whom had diabetic nephropaty and hypertensive nephrosclerosis. In our study we examined the case files of patients retrospectively whom had diabetes or hypertension and had attended our endocrinology policlinics between 1987 and 2009 years. We icluded 88 patients in our study whom had microalbuminuria and proteinuria values written in their files. Patients who had their basal datas and the ones whom doesn?t have were seperated. After analyzing our data we have found that glomerüler fitration rate were increasing with the increase at systolic blood pressure and diyastolic blood pressure. Microalbuminuria was increasing with an increase at body mass index. At the patient group whom basal datas were available, microalbuminuria was found to be significantly lower at the ones on angiotensin receptor antagonists therapy. As a result in this retrospective study, we have found that proteinuria values are regressing with antihypertensive treatment and this regression is more prominent at the angıotensin converting enzyme inhibitor group. We suggest that angıotensin converting enzyme inhibitors should be the first line therapy in this patient group and in case of having side effects as angioedema, hyperpotasemia, increase at renal failure and coughing the treatment should be switched to angiotensin receptor antagonists.
Abstract
It has been suggested in various trials that angıotensin converting enzyme inhibitors, angiotensin receptor antagonists and nondihydropyridin calcium channel antagonist impede the progress of microalbuminuria. We evaluated the effects of angıotensin converting enzyme inhibitors and angiotensin receptor antagonists on renal functions and on impeding the progress of microalbuminuria in patients whom had diabetic nephropaty and hypertensive nephrosclerosis. In our study we examined the case files of patients retrospectively whom had diabetes or hypertension and had attended our endocrinology policlinics between 1987 and 2009 years. We icluded 88 patients in our study whom had microalbuminuria and proteinuria values written in their files. Patients who had their basal datas and the ones whom doesn?t have were seperated. After analyzing our data we have found that glomerüler fitration rate were increasing with the increase at systolic blood pressure and diyastolic blood pressure. Microalbuminuria was increasing with an increase at body mass index. At the patient group whom basal datas were available, microalbuminuria was found to be significantly lower at the ones on angiotensin receptor antagonists therapy. As a result in this retrospective study, we have found that proteinuria values are regressing with antihypertensive treatment and this regression is more prominent at the angıotensin converting enzyme inhibitor group. We suggest that angıotensin converting enzyme inhibitors should be the first line therapy in this patient group and in case of having side effects as angioedema, hyperpotasemia, increase at renal failure and coughing the treatment should be switched to angiotensin receptor antagonists.
Açıklama
Tıpta Uzmanlık Tezi
Anahtar Kelimeler
Anjiotensin Dönüştürücü Enzim İnhibitörleri, Anjiotensin Reseptör Antagonistleri, Mikroalbumimüri, Angiotensin Converting Enzyme Inhibitors, Angiotensin Receptor Antagonists, Microalbuminuria
