Lisinopril kidney damage
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Lisinopril and Kidney Damage: A Comprehensive Review
Introduction to Lisinopril and Kidney Function
Lisinopril, an angiotensin-converting enzyme (ACE) inhibitor, is widely used to manage hypertension and heart failure. Its impact on kidney function, particularly in patients with pre-existing renal conditions, has been the subject of extensive research. This article synthesizes findings from multiple studies to provide a clear understanding of how lisinopril affects kidney health.
Lisinopril in Diabetic Nephropathy
Comparative Studies with Atenolol
Several studies have compared the effects of lisinopril and atenolol on kidney function in patients with diabetic nephropathy. One study found that both drugs effectively reduced the decline in kidney function over a 42-month period, with no significant differences in glomerular filtration rate (GFR) decline between the two groups. However, lisinopril was more effective in reducing urinary albumin excretion, a marker of kidney damage, by 55% compared to 15% with atenolol .
Long-Term Effects
Another long-term study compared lisinopril with nisoldipine, a calcium antagonist, in type 1 diabetic patients with nephropathy. Both drugs showed similar benefits in slowing the progression of kidney disease over four years. However, lisinopril significantly reduced albuminuria, indicating better protection against kidney damage.
Lisinopril in Chronic Allograft Nephropathy
A randomized controlled trial investigated the effects of lisinopril on patients with chronic allograft nephropathy. The study concluded that lisinopril did not adversely affect the rate of decline in graft function over one year. Additionally, it significantly reduced proteinuria and markers of renal tubular damage, suggesting a protective effect on kidney grafts.
Genetic Factors and Lisinopril Efficacy
The EURODIAB Controlled Trial examined the influence of ACE gene polymorphisms on the progression of renal disease in insulin-dependent diabetes mellitus (IDDM) patients. The study found that patients with the II genotype showed the fastest progression of albumin excretion rate (AER) on placebo but had a significantly enhanced response to lisinopril, indicating that genetic factors may influence the drug's efficacy.
Lisinopril and Oxidative Stress
Research on hypertensive rats induced with l-NAME (Nω-nitro-L-arginine methyl ester) showed that lisinopril treatment significantly reduced oxidative stress markers in renal tissues. The study demonstrated that lisinopril could reverse biochemical alterations associated with hypertensive renal damage, suggesting its potential in mitigating oxidative injury in the kidneys.
Lisinopril in Renal Transplant Patients
A study comparing nifedipine and lisinopril in hypertensive renal transplant patients found that both drugs were effective in managing blood pressure. However, patients treated with nifedipine showed a more significant improvement in kidney function over two years compared to those on lisinopril.
Conclusion
Lisinopril has demonstrated significant benefits in reducing markers of kidney damage, such as albuminuria, in various patient populations, including those with diabetic nephropathy and chronic allograft nephropathy. While its efficacy can be influenced by genetic factors, it generally offers protective effects against renal oxidative stress and damage. However, in renal transplant patients, other antihypertensive agents like nifedipine may offer superior long-term benefits. Overall, lisinopril remains a valuable option in the management of kidney-related complications in hypertensive patients.
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