A Prospective Multicenter Randomized Controlled Study Of The Antiproteinuric Effect Of Double Doses Of Fosinopril In Chronic Renal Diseases

Objective: Proteinuria is an independent risk factor in chronic kidney disease (CKD). It induces hyperplasy of mesenterium cell, activates alexin and Inflammatory reaction in renal interstitium. Proteinuria is increasingly being recognized for playing a dominant role as progression of kidney dysfunction. The renin-angiotensin-aldosterone system (RAAS) plays a pivotal role in these conditions in the development of renal lesions. Angiotensin converting enzyme inhibitor(ACEI) can effectively decrease the proteinuria, retard the development of glomerulosclerosis and tubulointerstitial lesions. The optimal dose of ACEI in human patients with renal disease is not known. We offen use the dose aimed to decrease blood pressure. It is being argued that high doses of ACEI maybe decrease the proteinuria more efficiently independent of change of blood pressure and maybe result in acute renal failure or hyperkalemia. Otherwise, most studys focus on the diabetic nephropathy,few cases respect to nondiabetic renal disease. Our present work is to investigate the possible therapeutical effect and safty of double doses of ACEI in chronic renal diseases by prospective multicenter randomized controlled study. .Method: 113 proteinuric patients with primary glomerular diseases, including 55 men and 58 women (mean age 50±13 years) were studied. They were randomly divided into two groups and used fosinopril in two different dosages (10mg·d-1 and 20 mg·d-1) for 12weeks. Blood pressure, proteinuria, serum cholesteron, serum creatinine , Ccr (calculated with MDRD formula), urinary N-acetyl-β-D-glucosaminidasewere measured at first and every 3 weeks after treatment.Results: The results showed (1) After 12 weeks therapy, Double doses of ACEI exerted more significant aniproteinuric effect compared to the single dose group [(57.9±5.1)% v(s41.5±3.5)%, p<0.01]. (2) The blood preasure reduction between the two groups had no remarkable difference (p>0.05). (3) During observation period, Ccr and serum potassium in double doses group had no significant change compared to the single dose group. (4) Uria NAG more significantly decend in double doses of ACEI group than the other.CONCLISION: 1. The double doses of ACEI has an superior aniproteinuric effect than the single dose. 2. This preferably result was independent of their antihypertensive effect. 3. The double doses of ACEI has no more adverse reaction than the single dose. 4. The double doses of ACEI more retard tubulointerstitial lesions.