EFFECT OF LOSARTAN ON SLOWING PROGRESSION OF CHRONIC ALLOGRAFT NEPHROPATHY

作     者：Ping-xian Wang Ming-qi Fan Chi-bing Huang Jia-yu Feng Ya Xiao Zhen-qiang Fang Yin-pu Zhang 

作者机构：Department of Urology Second Affiliated Hospital Third Military Medical University Chongqing 400037 

出 版 物：《Chinese Medical Sciences Journal》 (中国医学科学杂志（英文版）)

年 卷 期：2005年第20卷第4期

页      面：231-236,页

核心收录：

学科分类：1002[医学-临床医学] 100210[医学-外科学(含：普外、骨外、泌尿外、胸心外、神外、整形、烧伤、野战外)] 10[医学] 

主　　题：kidney transplantation nephropathy losartan transforming growth factor-beta1 

摘      要：Objective To investigate the effects of losartan, a specific angiotensin Ⅱ receptor blocker, on slowing progression of renal insufficiency in patients with biopsy-proven chronic allograft nephropathy （CAN） and the molecular mechanism of the therapy. Methods Twenty-two renal transplant recipients with biopsy-proven CAN （group A） were treated with losartan within two months after renal dysfunction for at least one year. Losartan was administered at a dose of 50 mg/d. Twenty-four recipients in the same fashion （group B） who never received angiotensin Ⅱ receptor antagonist were studied as control. The investigation time for each patient lasted one year. Renal functions and concentrations of plasma and urine transforming growth factor-betal （TGF-betal） were compared between the two groups at the initiation and end of the study. In group A, expressions of TGF-betal mRNA and immunofluorescence intensity of TGF-betal protein and pathological alterations in renal biopsy specimens were compared between before losartan therapy and after one year of the therapy. Results At the initiation of the investigation, no significant differences were found between group A and group B in clinical data such as donor age, cold-ischemia time, HLA mismatch, levels of creatinine clearance （Ccr）, plasma and urine TGF-betal concentrations. One year later, 14 of 22 （63.6%） patients showed stable or improved graft functions in group A, and 4 of 24 （16.7%） in group B. The difference was significant （P 〈 0.05）. At the end of the study, urine TGF-betal concentration was 273.8 ± 84.1 pg/*** in group A and 457.2 ± 78.9 pg/*** in group B. During one year study period, loss of Ccr was 6.6 ± 5.4 mL/min in group A and 16.2 ± 9.1 mL/min in group B. Both of the differences were significant between the two groups （P 〈 0.01）. No significant differences were found in plasma TGF-betal concentrations between the four values determined at the initiation and end of the study in the two groups （F= 2.56, P〉