The Effects of Adding Spironolactone to ACEI or ARB on Proteinuria in Type ۲ Diabetes

Abstract Objectives: Interruption of rennin-angiotensin-aldosterone system has become a leading therapeutic strategy in the treatment of diabetic nephropathy however, ACEIs and ARBs do not uniformly suppress the rennin-angiotensin-aldosterone system. Plasma aldosterone levels are elevated in a group of patients despite therapy and this phenomenon known as aldosterone escape or aldosterone break through. Materials and Methods: Forty-two type ۲ diabetic patients with overt proteinuria were randomized into two groups and according to double-blind case-control study, one group was treated with spironolactone and others were treated with placebo for ۴ months. Twenty-four hours urine protein, glomerular filtration rate (GFR) and blood pressure were measured at baseline and after ۴ months of treatment. Serum potassium was checked at baseline and one month of treatment. Results: Urine protein decreased in case group by ۲۶.۵% at the end of ۴ months, but increased in control group by ۱۷.۹% (P=۰.۰۰۳). GFR did not have any significant change in case group (P<۰.۳۵۴), but decreased in case group significantly (P<۰.۰۰۱). Conclusion: Our study showed that spironolactone ۱۲.۵ mg/day is safe (without hyperkalemia and gynecomastia) and effective to decrease proteinuria in diabetic patient with CKD۱-۲.

کلیدواژه ها:

Diabetic nephropathy ، Aldosterone ، Spironolactone ، Aldosterone escape ، Chronic kidney disease.