Re: [討論] 關於蛋白尿首選藥物
※ 引述《hahawow (哇哈哈)》之銘言：
: Kidney Int. 2012 Mar;81(6):586-94.
: Combined intensive blood pressure and glycemic control does not produce
: an additive benefit on microvascular outcomes in type 2 diabetic patients.
: ACCORD Study Group.
感謝大大用心, 不回文都不好意思了 (汗),
降尿蛋白的治療策略或想法, 還是比較侷限在腎內領域, 而非一般內科領域;
這當然隱含這一種意義: 就是這類治療仍在發展中, 專家們都還未能有定論,
更別說是其它科醫師了....
一般而言, 若以治療方法來切入, 許多合併ACEI/ARB/DRI的研究, 就是在回答此一問題
我個人並沒有做過此專題, 因此無法給很好的文獻索引,
但, 至少這個想法, 連腎內教科書都已經寫進去了, 那也不能說太新穎了....
-----以下引用2012年出版的腎臟教科書------
最早年的MDRD研究, 就已經觀察到蛋白尿程度和腎病進展有關(獨立於血壓);
Peterson JC, Adler S, Burkart JM, et al. Blood pressure control, proteinuria,
and the progression of renal disease: the Modification of Diet in Renal
Disease study. Ann Intern Med. 1995;123(10):754-762.
再來,藉由其它primary endpoint並非蛋白尿及腎功能的研究,也觀察到類似的結論:
不管是DM或非DM,蛋白尿程度是很強的預測腎病惡化的因子
de Zeeuw D, Remuzzi G, Parving HH, et al. Proteinuria, a target for
renoprotection in patients with type 2 diabetic nephropathy: lessons from
RENAAL. Kidney Int. 2004;65(6):2309-2320.
Atkins RC, Briganti EM, Lewis JB, et al. Proteinuria reduction and
progression to renal failure in patients with type 2 diabetes mellitus and
overt nephropathy. Am J Kidney Dis. 2005;45(2):281-287.
另外, 其實很早就有人做出這個meta-analysis了:簡單講,經過治療而達到的蛋白尿
程度,會預測ESRD;
Jafar TH, Schmid CH, Landa M, et al. Angiotensin-converting enzyme
inhibitors and progression of nondiabetic renal disease. A meta-analysis of
patient-level data. Ann Intern Med. 2001;135(2):73-87.
有了前人的觀察及分析, 才有可能有後人的RCT:
Hou FF, Xie D, Zhang X, et al. Renoprotection of Optimal Antiproteinuric
Doses (ROAD) study: a randomized controlled study of benazepril and losartan
in chronic renal insufficiency. J Am Soc Nephrol. 2007;18(6): 1889-1898.
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