Effect of combining ACE inhibition with aldosterone blockade on proteinuria and renal damage in experimental nephrosis.

Abstract

Aldosterone has pro-fibrotic properties and is a potential target for additional intervention in patients with chronic renal disease showing resistance to therapy during treatment with angiotensin-converting enzyme inhibitors (ACEi). Combining ACEi and aldosterone receptor blockade (aldoRB) in proteinuric renal disease reduces proteinuria, but effects on proteinuria-induced renal damage are unknown. We studied the effect of ACEi/aldoRB in adriamycin nephrosis (AN). Six weeks after injection of adriamycin in Wistar rats, randomized treatment with vehicle (VEH, n=8), aldoRB (n=12), ACEi (n=10), or a combination of ACEi/aldoRB (n=14) was given for 12 weeks. Healthy rats served as controls (n=6). Renal damage was quantified by markers of tubular injury (osteopontin (OPN) and kidney injury molecule-1 (Kim-1)), pre-fibrotic lesions (alpha-smooth muscle actin (SMA)), interstitial fibrosis (IF), and focal glomerulosclerosis (FGS). In AN animals, proteinuria was increased compared with controls. ACEi and ACEi/aldoRB significantly reduced proteinuria compared with VEH, whereas aldoRB monotherapy was without effect. Blood pressure was reduced in ACEi and ACEi/aldoRB compared with VEH and aldoRB. OPN and Kim-1 were increased in AN animals, but significantly reduced by ACEi/aldoRB. Treatment with ACEi and ACEi/aldoRB prevented an increase of SMA, IF, and FGS. In conclusion, ACEi/aldoRB effectively reduced proteinuria and markers of tubular injury and prevented renal damage in this rat model of chronic proteinuria-induced renal damage.

• Authors: A B Kramer, E F van der Meulen, I Hamming, H van Goor, G Navis
• Journal: Kidney international (Kidney Int) Vol. 71 Issue 5 Pg. 417-24 (Mar 2007) ISSN: 0085-2538 [Print] United States
• PMID: 17213874 (Publication Type: Journal Article, Research Support, Non-U.S. Gov't)

Chemical References

• Actins
• Angiotensin-Converting Enzyme Inhibitors
• Biomarkers
• Cell Adhesion Molecules
• Collagen Type IV
• Havcr1protein, rat
• Membrane Proteins
• Mineralocorticoid Receptor Antagonists
• smooth muscle actin, rat
• Osteopontin
• Aldosterone
• Peptidyl-Dipeptidase A

Topics

• Actins (analysis)
• Aldosterone (metabolism)
• Angiotensin-Converting Enzyme Inhibitors (therapeutic use)
• Animals
• Biomarkers (analysis)
• Blood Pressure (drug effects)
• Cell Adhesion Molecules (analysis)
• Collagen Type IV (analysis)
• Disease Models, Animal
• Drug Therapy, Combination
• Glomerulosclerosis, Focal Segmental (prevention & control)
• Kidney (chemistry, pathology)
• Membrane Proteins (analysis)
• Mineralocorticoid Receptor Antagonists (therapeutic use)
• Nephrosis (drug therapy, etiology, pathology)
• Osteopontin (analysis)
• Peptidyl-Dipeptidase A (metabolism)
• Proteinuria (complications, drug therapy)
• Rats
• Rats, Wistar