Aliskiren reduces albuminuria and oxidative stress, and elevates glomerular filtration rates in Japanese patients with advanced diabetic nephropathy

摘要

Inhibition of renin angiotensin system is important in the treatment of diabetic nephropathy. At present, angiotensin II receptor blockers (ARBs) and angiotensin-converting enzyme inhibitors (ACEIs) are being widely used clinically for this purpose. However, although these drugs decrease the urinary albumin excretion volume (urinary albumin-to-creatinine ratio: ACR), they also decrease the estimated glomerular nitration rate (eGFR). They also have the problem of increasing renin activity because of negative feedback.1 Aliskiren, a direct renin blocker, was released in Japan in recent years, and the drug's safety and hypotensive effects have already been reported.2'3 However, there are still few reports in Japan on the drug's effects on diabetic nephropathy. Although reports have already been released overseas on aliski-ren's renal protection effects when used in combination with ACEIs and/or ARBs, as well as its effects against eGFR, there are very few such reports on Japanese patients. A basic study has shown aliskiren's potential to demonstrate renal oxidative stress suppression effects as well as renal protective actions by suppressing macrophage infiltration.6'7 We therefore administered aliskiren to advanced diabetic nephropathy patients who were already taking ARBs and/or ACEIs, and observed the changes in ACR and eGFR. We also observed urinary oxidative stress (8-hydroxydeoxyguanosine: 8-OHdG), inflammatory chemokine (monocyte chemoattrac-tant protein-1: MCP-1) and inflammatory cytokine (interleukin-6: IL-6) excretions.