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당뇨병성신증에서 전환효소억제제인 Captopril 이 신기능 및 단백뇨에 미치는 영향
김태용(Tae Yong Kim),이성계(Sung Gye Lee),서보원(Bo Won Suh),김수방(Su Bang Kim),양상호(Sang Ho Yang),김홍기(Hong Khee Kim),박요한(Yo Han Park),이재우(Jae Woo Lee),이시래(Si Rhae Lee) 대한내과학회 1990 대한내과학회지 Vol.39 No.4
N/A Short-term administration of captopril, a converting enzyme inhibitor, to patients with diabetic nephropathy is known to reduce proteinuria by lowering glomerular hypertension. However, clinical reports describing the long-term influence of this medication on proteinuria and renal function are hardly met with. We, therefore, investigated if long-term administration of captopril has the same effect on proteinuria and preseves renal function more effectively than other antihypertensives inpatients with diabetic nephropathy and hypertension. Twenty-two patients were divided into two groups: 11 (Group I) treated with captopril and another 11 (Group II) with conventional antihypertensives. Both groups were followed up for an average of 20 months (6-32mo). Regarding proteinuria in Group I, 24-hour urinary excretion of protein decreased from 7.4±3.4 g (N = 11) to 5.1±2.9 g (N =10) in 1 week (p <0.05), and then it slowly declined to 3.6±0.6 g (N =5) (p<0.05) at the end of a 24 month follow up period. In Group II, however, the protein excretion did not change significantly during the 18 months of treatment, after which it tended to increase. The serum albumin level started to increase (p< 0.05) in Group I after 1 week and rose from 2.7±0.4 g/dl (N=11) to 3.1±0.5g/dl (N=5) in 24 months, but it showed no apparent variation in Group II. In both groups the serum creatinine concentration increased gradually during the course of treatment, however, the rate of increment was slightly lower in Croup I (0.072 mg/dl/mo) compared with Group II (0.123 mg/dl/mo). Consequently, the rate of reduction in 1/Scr appeared to be slightly lower in the former (-0.01349 100 ml/mg/ mo) than in the latter (-0.01833 100 ml/mg/mo), although the difference was not statistically significant. Plasma renin activity increased and the plasma aldolsterone level decreased in Group I, but no apparent change was observed for both variables in Group II. In conclusion, long-term captopril treatment in patients with diabetic nephropathy and hypertension decreased proteinuria significantly and slowed the progression of renal failure compared to those patients treated with other antihypertensives, Captopril can be used relatively safely in these patients over a long-term period and may be a preferred medication to other antihypertensives.