Lisinopril renal function
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Lisinopril and Renal Function: A Comprehensive Review
Introduction to Lisinopril and Renal Function
Lisinopril, an angiotensin-converting enzyme (ACE) inhibitor, is widely used to manage hypertension and various renal conditions. Its impact on renal function, particularly in patients with different types of nephropathies, has been extensively studied. This article synthesizes findings from multiple research studies to provide a clear understanding of how lisinopril affects renal function.
Lisinopril in Hypertensive Renal Transplant Patients
Comparative Efficacy with Nifedipine
In hypertensive renal transplant patients treated with cyclosporin, lisinopril was compared to nifedipine over a two-year period. Both medications were effective in managing hypertension, but nifedipine showed a more significant improvement in glomerular filtration rate (GFR) compared to lisinopril. After one year, the GFR increased by 9.6 ml/min more in the nifedipine group than in the lisinopril group, and this difference remained significant after two years.
Lisinopril in Diabetic Nephropathy
Normotensive Patients with Insulin-Dependent Diabetes
A study involving normotensive patients with insulin-dependent diabetes mellitus (IDDM) and varying levels of albuminuria found that lisinopril significantly slowed the progression of renal disease. The greatest benefit was observed in patients with microalbuminuria, where lisinopril reduced the urinary albumin excretion rate (AER) by 34.2 µg/min compared to placebo .
Hypertensive Non-Insulin-Dependent Diabetes Mellitus (NIDDM) Patients
In hypertensive NIDDM patients with diabetic nephropathy, lisinopril was compared to atenolol. Both drugs effectively reduced blood pressure, but lisinopril was more effective in reducing albuminuria. The study found a 45% reduction in albuminuria with lisinopril compared to a 12% reduction with atenolol, although the decline in GFR was similar in both groups .
Lisinopril in Non-Diabetic Nephropathies
Mild Proteinuric Non-Diabetic Nephropathies
Lisinopril was also studied in patients with non-diabetic chronic renal diseases and mild proteinuria. Over a follow-up period of approximately 22.5 months, lisinopril significantly slowed the decline in renal function compared to other antihypertensive agents. The decline in inulin clearance was markedly less in the lisinopril group (-1.31 ml/min/1.73 m²) compared to the control group (-6.71 ml/min/1.73 m²).
Lisinopril in Chronic Allograft Nephropathy
Proteinuria and Renal Function Preservation
In patients with chronic allograft nephropathy, lisinopril was shown to reduce proteinuria and preserve renal function. The study indicated that lisinopril significantly decreased proteinuria and reduced renal proximal tubular polypeptide catabolism, plasma aldosterone, and ammonia excretion, suggesting a relative preservation of graft function.
Long-Term Renoprotective Effects
Comparison with Calcium Antagonists
Long-term studies comparing lisinopril with calcium antagonists like nisoldipine in type 1 diabetic patients with diabetic nephropathy showed that both drugs had similar effects on the progression of nephropathy. However, lisinopril was more effective in reducing albuminuria initially, while the long-term decline in GFR was comparable between the two treatments.
Conclusion
Lisinopril has demonstrated significant benefits in managing renal function across various patient populations, including those with diabetic and non-diabetic nephropathies, as well as renal transplant recipients. While it effectively reduces proteinuria and slows the progression of renal disease, its comparative efficacy with other antihypertensive agents varies depending on the specific patient population and condition. Overall, lisinopril remains a valuable option in the therapeutic arsenal for preserving renal function.
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