Tropical Journal of Pharmaceutical Research

Original Research Article | OPEN ACCESS

Effect of dual blockade of renin-angiotensin aldosterone system on proteinuria in patients with diabetic nephropathy and advanced azotemia

Hatice Odabas¹, Ilyas Capoglu², Ramazan Cetinkaya³, Ali Riza Odabas³, Abdullah Uyanik³, Mustafa Keles³

¹Department of Internal Medicine; ²Department of Endocrinology and Metabolism; ³Department of Nephrology, Faculty of Medicine, Ataturk University, Erzurum, Turkey.

For correspondence:- Mustafa Keles Email: keles.m@gmail.com Tel:+904422317250

Received: 26 September 2014 Accepted: 20 August 2015 Published: 31 October 2015

Citation: Odabas H, Capoglu I, Cetinkaya R, Odabas AR, Uyanik A, Keles M. Effect of dual blockade of renin-angiotensin aldosterone system on proteinuria in patients with diabetic nephropathy and advanced azotemia. Trop J Pharm Res 2015; 14(10):1885-1891 doi: 10.4314/tjpr.v14i10.21

© 2015 The authors.
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Abstract

Purpose: To investigate the dual effect of angiotensin blockade by irbesartan and enalapril on proteinuria in diabetic patients with azotemia.

Methods: Patients with diabetes of > 5 years duration, proteinuria at a nephrotic level and serum creatinine > 1.5 mg/dL were enrolled in the study. Forty-five enrolled patients were divided into three groups, those receiving enalapril , irbesartan, or enalapril plus irbesartan, respectively, over a period of 24 weeks. Urinary protein excretion and serum level of albumin, creatinine, potassium were measured before and after treatment

Results: In patients receiving enalapril, irbesartan, and both drugs concomitantly, mean urinary protein excretion level decreased significantly at the end of 6 months from 6.46 ± 4.66 to 3.36 ± 1.60, 5.89 ± 5.34 to 3.22 ± 1.72 and 5.99 ± 3.77 to 2.10 ± 2.22 g/day, respectively (p = 0.001). Decrease in proteinuria in the group receiving the combined therapy was more significant than the other two groups (p = 0.025). During the period of therapy, serum albumin increased and mean arterial pressure decreased significantly (p = 0.02 and p = 0.002, respectively) but serum creatinine and potassium and creatinine clearance values showed insignificant increases (p = 0.28 and p = 0.57, respectively).

Conclusion: The combined use of enalapril and irbesartan, in patients with diabetic nephropathy associated with azotemia, is more effective in decreasing proteinuria without causing any substantial increase in serum potassium levels. The combined use of these two drugs shows a more pronounced anti-proteinuric effect.

Keywords: Angiotensin-converting enzyme inhibitor, Angiotensin receptor blocker, Diabetic nephropathy, Azotemia, Proteinuria, Aldosterone, Renin, Blood pressure