2018, Número 4
<< Anterior Siguiente >>
Rev Clin Esc Med 2018; 8 (4)
Proteccion renal con ARA II e IECA en pacientes diabéticos Normotensos-Normoalbuminuricos
Ojeda CAO, Ojeda CAX, Ojeda CAE, Ojeda CPO, Sánchez LV
Idioma: Español
Referencias bibliográficas: 33
Paginas: 1-9
Archivo PDF: 433.39 Kb.
RESUMEN
Evaluar el efecto de los IECAS o ARA II en los pacientes
con DMII normoalbuminuricos normotensos como
nefroprotectores y prevenir a futuro las complicaciones
irreversibles, como su evolución a la nefropatía diabética e
hipertensión.
Material y métodos: Se está realizando
estudio descriptivo transversal con 120 pacientes de 30
- 60 años de edad DM II desde el 2003 hasta la actualidad
normotensos y normoalbuminuricos de los cuales 61
son hombres y 59 mujeres con varios factores de riesgo
como obesidad, sobrepeso, antecedentes de enfermedades
coronarías familiares, y sedentarios en su mayoría; 74
pacientes reciben enalapril (IECA) 5mg y 56 pacientes
candesartan 4mg (ARAII) por las noches continuamente
desde el momento que se detecta su DM II.
Resultados:
La prevención de la microalbuminuria, a pesar de sus
limitaciones, es clínicamente importante en la atención
de nuestros casos como una propuesta noble, práctica,
realizable, de bajo costo y con resultados extraordinarios en
la prevención primaria en el presente y futuro de los pacientes
con DM II. Además porque los IECAS y ARAII recién son
utilizados cuando el paciente presenta un daño irreversible
con un futuro incierto. Porque no antes es mi pregunta para
los científicos e investigadores del mundo entero.
Discusión:
Comparto mi experiencia de más de 14 años utilizando en
dosis bajas enalapril 5mg o candesartan 4mg ingeridos por las
noches continuamente en pacientes que debutan con DMII
normoaalbuminuricos sin hipertensión arterial respaldado
por los estudios de intervención sobre micro albuminuria como el el IRMA 2, IDNT, RENAAL GLOMERULAAR,
COOPERATE, AVOID,BENEDICT.
REFERENCIAS (EN ESTE ARTÍCULO)
1.-Catalá-López, F., Macías Saint-Gerons, D., González-Bermejo, D., Rosano, G., Davis, B., & Ridao, M. et al. Cardiovascular and Renal Outcomes of Renin–Angiotensin System Blockade in Adult Patients with Diabetes Mellitus: A Systematic Review with Network Meta-Analyses. Plos Med, 2016. 13(3), e1001971.
2.-Cheng, J., Zhang, W., Zhang, X., Han, F., Li, X., & He, X. et al. Effect of Angiotensin-Converting Enzyme Inhibitors and Angiotensin II Receptor Blockers on All-Cause Mortality, Cardiovascular Deaths, and Cardiovascular Events in Patients with Diabetes Mellitus. JAMA Internal Medicine, 2014. 174(5), 773.
3.-Bangalore, S., Fakheri, R., Toklu, B., & Messerli, F. Diabetes mellitus as a compelling indication for use of renin angiotensin system blockers: systematic review and meta-analysis of randomized trials. BMJ, 2016. i438.
4.-ESC Guidelines on diabetes, pre-diabetes, and cardiovascular diseases developed in collaboration with the EASD. The Task Force on diabetes, prediabetes, and cardiovascular diseases of the European Society of Cardiology (ESC) and developed in collaboration with the European Association for the Study of Diabetes (EASD). Revista Española De Cardiología (English Edition), 2014. 67(2), 136.
5.-Palmer, S., Mavridis, D., Navarese, E., Craig, J., Tonelli, M., & Salanti, G. et al. Comparative efficacy and safety of blood pressure-lowering agents in adults with diabetes and kidney disease: a network meta-analysis. The Lancet, 2015. 385(9982), 2047- 2056z
6.-Tikellis, C., Brown, R., Head, G., Cooper, M., & Thomas, M. Angiotensin-converting enzyme 2 mediates hyperfiltration associated with diabetes. AJP: Renal Physiology, 2014. 306(7), F773-F780.
7.- Lindhardt, M., Persson, F., Currie, G., Pontillo, C., Beige, J., & Delles, C. et al. Proteomic prediction and Renin angiotensin aldosterone system Inhibition prevention Of early diabetic nephropathy in Type 2 diabetic patients with normoalbuminuria (PRIORITY): essential study design and rationale of a randomised clinical multicentre trial. BMJ Open, 2016. 6(3), e010310.
8-Sauter, N., Thienel, C., Plutino, Y., Kampe, K., Dror, E., & Traub, S. et al. Angiotensin II Induces Interleukin-1β–Mediated Islet Inflammation and β-Cell Dysfunction Independently of Vasoconstrictive Effects. Diabetes, 2014. 64(4), 1273-1283.
9.-Viazzi, F., Leoncini, G., & Pontremoli, R. Antihypertensive Treatment and Renal Protection: the role of drugs inhibiting the renin-angiotensinaldosterone system. High Blood Pressure & Cardiovascular Prevention, 2013. 20(4), 273-282. http://dx.doi.org/10.1007/s40292-013-0027-
Siwy J, Schanstra JP, Argiles A, et al. Multicentre prospective validation of a urinary peptidomebased classifier for the diagnosis of type 2 diabetic nephropathy. Nephrol Dial Transplant 2014; 29:1563–70
11.-Nasri, H. & Rafieian-Kopaei, M. On the occasion of world kidney day 2016; work together to better protect the kidney. Journal of Nephropathology, 2015. 5(1), 15-18.
12.-Schmieder, R., Schutte, R., Schumacher, H., Böhm, M., Mancia, G., & Weber, M. et al. Mortality and morbidity in relation to changes in albuminuria, glucose status and systolic blood pressure: an analysis of the ONTARGET and TRANSCEND studies. Diabetologia, 2014. 57(10), 2019-2029.
13.-Odegaard, A., Jacobs, D., Sanchez, O., Goff, D., Reiner, A., & Gross, M. Oxidative stress, inflammation, endothelial dysfunction and incidence of type 2 diabetes. Cardiovascular Diabetolology, 2016.15(1).
14.-Guo, H., Liao, X.,Liu, Q., & Zhang, L. Angiotensin II Type 2 Receptor Decreases Transforming Growth Factor-β Type II Receptor Expression and Function in Human Renal Proximal Tubule Cells. PLOS ONE, 2016. 11(2), e014869 6
15.-Pinsker, J., Shank, T., Dassau, E., & Kerr, D. Comment on American Diabetes Association. Approaches to Glycemic Treatment. Sec. 7. In Standards of Medical Care in Diabetes-2015. Diabetes Care 2015; 38(Suppl. 1):S41–S48. Diabetes Care, 2015. 38(10), e174-e174.
16.-Górriz, J., Nieto, J., Navarro-González, J., Molina, P., Martínez-Castelao, A., & Pallardó, L. Nephroprotection by Hypoglycemic Agents: Do We Have Supporting Data? Journal of Clinical Medicine, 2015. 4(10), 1866-1889.
17.-Kropelin, T., de Zeeuw, D., Andress, D., Bijlsma, M., Persson, F., Parving, H., & Lambers Heerspink, H. Number and Frequency of Albuminuria Measurements in Clinical Trials in Diabetic Nephropathy. Clinical Journal Of The American Society Of Nephrology, 2015. 10(3), 410-416.
18.-Campbell, K. & Yacoub, R. Inhibition of RAS in diabetic nephropathy. IJNRD, 2015. 29.
19.- Parving HH, Persson F, Rossing P. Microalbuminuria: a parameter that has changed diabetes care. Diabetes Res Clin Pract 2015; 107:1–8.
Bhatti A, Usman M. Drug Targets for Oxidative Podocyte Injury in Diabetic Nephropathy. Cureus. 2015.
21-.-Yixuan Shi, R. & Shao-Ling Zhang, C. Angiotensin-(1-7): A Novel Peptide to Treat Hypertension and Nephropathy in Diabetes? Journal of Diabetes & Metabolism, 2015. 6(10).
22.-Dominici, F., Burghi, V., Muñoz, M., & Giani, J. Modulation of the action of insulin by angiotensin-(1–7). Clin. Sci., 2014. 126(9), 613-630.
23.-James, P., Oparil, S., Carter, B., Cushman, W., Dennison-Himmelfarb, C., & Handler, J. et al. Evidence-Based Guideline for the Management of High Blood Pressure in Adults. JAMA, 2014311(5), 507.
24.-Tapia, E., Sánchez-Lozada, L., García-Niño, W., García, E., Cerecedo, A., & García-Arroyo, F. et al. Curcumin prevents maleate-induced nephrotoxicity: Relation to hemodynamic alterations, oxidative stress, mitochondrial oxygen consumption and activity of respiratory complex I. Free Radical Research, 2014. 48(11), 1342-1354.
25.- Patel, V., Clarke, N., Wang, Z., Putko, B., Parajuli, N., & Lo, J. et al. Angiotensin II Induced Proteolytic Cleavage of Angiotensin Converting Enzyme 2 Is Mediated Via the Tnf-Alpha Converting Enzyme (TACE/ADAM-17): A Positive Feedback Mechanism in the Renin Angiotensin System. Canadian Journal of Cardiology, 2013. 29(10), S115.
26.- Costanzo, P., Cleland, J., Vassallo, E., & Perrone- Filardi, P. Effects of angiotensin converting enzyme inhibitors and angiotensin receptors blockers on cardiovascular events in patients with or at high risk of cardiovascular disease but without heart failure. a combined analysis of randomized clinical trials. Journal Of The American College Of Cardiology, 2012. 59(13), E1757.
27.-Roscioni, S., Lambers Heerspink, H., & de Zeeuw, D. Microalbuminuria: target for renoprotective therapy PRO. Kidney International, 2014.86(1), 40- 49.
28.-Andrésdóttir, G., Jensen, M., Carstensen, B., Parving, H., Rossing, K., Hansen, T., & Rossing, P. Improved Survival and Renal Prognosis of Patients with Type 2 Diabetes and Nephropathy with Improved Control of Risk Factors. Diabetes Care, 2014. 37(6), 1660-1667.
29.-Schmieder, R., Mann, J., Schumacher, H., Gao, P., Mancia, G., & Weber, M. et al. Changes in Albuminuria Predict Mortality and Morbidity in Patients with Vascular Disease. Journal of the American Society of Nephrology, 2011.22(7).
30.-Mori, J., Patel, V., Ramprasath, T., Alrob, O., DesAulniers, J., & Scholey, J. et al. (2014). Angiotensin 1-7 mediates renoprotection against diabetic nephropathy by reducing oxidative stress, inflammation, and lipotoxicity. AJP: Renal Physiology, 2014.306(8).
Mahmood I, Abed M, Merkhan M. Effects of blocking of angiotensin system on the prevalenceof metabolic syndrome in type 2 diabetic patients. Pakistan Journal of Medical Sciences. 2012; 29(1).
Leehey D, Singh A, Alavi N, Singh R. Role of angiotensin II in diabetic nephropathy. Kidney International. 2010; 58:S93-S98.
Sharaf El Din U, Salem M, Abdulazim D. Diabetic nephropathy: Time to withhold development and progression - A review. Journal of Advanced Research. 2017;8(4):363-373.