In diabetic nephropathy effective blockade of aldosterone

In diabetic nephropathy effective blockade of aldosteroneIn diabetic nephropathy effective blockade of aldosterone ACE inhibitors reduce proteinuria and slow the progression of diabetic nephropathy, explain the authors, however, often these favorable effects were not observed because of 'escapes' aldosterone link of pathogenesis. Dr. Atsuhisa Sato and his colleagues (Clinic red cross, Mito, Ibaraki, Japan) studied the role of 'escapes' of aldosterone and the blockade of the action of aldosterone spironolactone 45 patients with type 2 diabetes and initial stages of nephropathy, already receiving an ACE inhibitor. For 40 weeks of treatment with ACE inhibitor, the average excretion of albumin in the urine (AUM) decreased by approximately 40%; the average plasma concentration of aldosterone during this time has not changed. The concentration of plasma aldosterone gradually increased in 18 patients (40%), and in this subgroup values EAM were significantly higher. Of these 18 patients with aldosteronoma 'evasion' 13 took spironolactone (25 mg/day). For the next 24 weeks they have managed to achieve a significant decrease aim. 'It is possible that the blockade of aldosterone is the best therapy for patients with incipient diabetic nephropathy, which in patients receiving ACE inhibitors observed 'evasion' of aldosterone, and cease to manifest antiproteinuric effects of ACE inhibitors', says Dr. Sato. 'Plasma levels of aldosterone may not be reduced when receiving standard doses of ACE inhibitors', he adds. 'We believe that the combination of antagonist mineralocorticoid receptors and ACE inhibitor may be optimal even for patients without aldosterone 'escapes'. This clinical trial is already carried out in our Institute'. Source: Solvay Pharma.



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