Proteinuria, a target for renoprotection in patients with type 2 diabetic nephropathy: Lessons from RENAAL

摘要: Proteinuria, a target for renoprotection in patients with type 2 diabetic nephropathy: Lessons from RENAAL. Background Proteinuria or albuminuria is an established risk marker progressive renal function loss. Albuminuria can be effectively lowered antihypertensive drugs that interrupt the renin-angiotensin system (RAS). We investigated whether could not only serve as of disease, but also monitor renoprotective efficacy RAS intervention by angiotensin II (Ang II) antagonist, losartan, nephropathy. Methods The data RENAAL (Reduction End Points Noninsulin-Dependent Diabetes Mellitus Angiotensin Antagonist Losartan) study, double-blind, randomized trial, were used to examine effects losartan on outcome [i.e., primary composite end point doubling serum creatinine, end-stage disease (ESRD) death] 1513 examined effect degree at baseline, initial antiproteinuric response therapy, and remaining (residual) (either ESRD). evaluated contribution protection independently changes blood pressure. Results Baseline almost linearly related outcome, strongest predictor among all measured well-known baseline parameters. After adjusting markers age, gender, race, weight, smoking, sitting diastolic pressure, systolic total cholesterol, albuminuria, hemoglobin, hemoglobin A 1c (HbA ) high (≥3.0g/g creatinine) showed 5.2-fold (95% CI 4.3–6.3) increased reaching point, 8.1-fold 6.1–10.8) progressing ESRD, compared low group ( Conclusion predominant nephropathy conventional treatment; higher greater risk. Reduction associated proportional protection, reduction protection. residual therapy (month 6) strong albuminuria. explains major component its specific effect. In conclusion, should considered loss diabetes nephropathy, well therapy. lowest achievable level viewed goal future treatments.