Which kind of drug should be combined with sartan or puril, will the protein-lowering effect of kidney disease be better?

Zhou Xun, Chief Physician of Nephrology

High proteinuria is one of the main manifestations of kidney disease patients, and it is also The main risk factor leading to the progressive progression of chronic kidney disease, that is to say, the slow or gradual increase of serum creatinine in most patients with kidney disease is related to the urine protein obviously exceeding the normal range. Therefore, in the face of kidney disease patients with high proteinuria, protein-lowering treatment is very important and necessary.

It has been proven and recognized that sartan or puril drugs not only have the effect of lowering systemic blood pressure In addition to reducing systemic blood pressure, sartan or puril drugs also have the effect of reducing the “three highs” in the glomerulus, thereby protecting the kidneys and reducing protein. This is the main reason why some patients with kidney disease are also using sartan or puril drugs when their blood pressure is not high, especially commonly used in patients with glomerulonephritis, such as IgA nephropathy and allergic purpura nephritis, etc. often choose to use timi Sartan and other sartan drugs.

However, not all kidney diseases have a very good protein-lowering effect after using sartan or puril drugs , or the decrease in urine protein is not obvious, or only a slight decrease in urine protein. why? We know that sartan or puril drugs belong to renin-angiotensin-aldosterone system blockers (RAS blockers), and its main function is to reduce the “three highs” in the glomerulus, that is, high pressure , high filtration and high perfusion, etc., through this mechanism, thereby playing the role and effect of reducing protein and protecting the kidneys.

That is to say, This effect is not strong, or in other words, the effect of lowering protein may be even less obvious if the desired effect and sufficient use time are not achieved. There is still a big difference from drugs with strong effects such as glucocorticoids or immunosuppressants. When the urine protein is relatively high or very high, or when encountering a kidney disease that is difficult to treat, the “power” of the protein-lowering drug is obviously not enough to use only RAS blockers. At this time, it is necessary to consider combining other drugs. Drugs to achieve better protein-lowering effects, thereby avoiding or delaying the progression of kidney disease to chronic renal insufficiency and uremia.

If patients with kidney disease want to have a better protein-lowering effect, sartan or puril drugs can be considered with the following: used in combination with drugs.

1. Glucocorticoid

Generally speaking, as long as there are no contraindications, kidney disease with a 24-hour urinary protein quantity exceeding 3.5 grams (adults) should be considered Use of glucocorticoids, such as nephrotic syndrome, or even 24-hour urine protein quantification of more than 1.0 grams should consider the use of such drugs, such as IgA nephropathy. The higher the urine protein, the less effective the protein-lowering effect of drugs such as sartan or puril alone will be. After the combined use of glucocorticoids, the protein-lowering effect will be better.

2. Immunosuppressants

Immunosuppressant drugs are also commonly used to reduce protein in patients with kidney disease who are not well treated by sartan or puril Treatment, tripterygium glycosides tablets, leflunomide, mycophenolate mofetil, tacrolimus and cyclosporine are all immunosuppressant drugs, membranous nephropathy with high urinary protein, focal segmental glomerulosclerosis, IgA nephropathy, lupus nephritis, Henoch-Schonlein purpura nephritis, and hepatitis B virus-related nephritis, etc., can use one of the above immunosuppressants on the basis of using sartan or puril drugs. The effect will be better.

Three. Statins

Urinary protein in some kidney diseases It’s not too high, but the patient’s 24-hour urine volume still continues to exceed 0.3-0.5 grams, or more than 0.8 grams. Although sartan or puril drugs are used, the effect is not obvious. At the same time, the patient also had hyperlipidemia, especially elevated total cholesterol. At this time, patients may consider using statins (such as atorvastatin) in combination. Don’t think that statins only have lipid-lowering effects. In fact, these drugs also have protein-lowering effects other than lipid-lowering. Even without hyperlipidemia, patients can choose to use these drugs.

Four. List of drugs

Chronic kidney disease with high proteinuria is not too high or significantly elevated, patients can consider using Liejing drugs . Some people say that Liejing drugs belong to a category of hypoglycemic drugs, and they can only be used if there is diabetes. If that’s all you know, you’re behind the curve. Whether it is diabetic nephropathy, non-diabetic chronic kidney disease, high or not high blood sugar, patients can choose to use sartan or puril drugs to reduce the elevated urinary protein. Of course, rowan drugs can also be used in conjunction with statins or hormones and immunosuppressants, and the effect will be better.

< span>5. Other auxiliary drugs

Drugs with good protein-lowering effects are far away Not only the above categories, but also more than these categories of drugs used in conjunction with sartan or puril. Among the Chinese patent medicines, Shenyankang Capsules, Shenyan Kangfu Tablets, Huangkui Capsules and Jianshen Capsules can also be used according to TCM syndrome differentiation, and the protein-lowering effect will be better. Other auxiliary drugs, such as active vitamin D (such as calcitriol), anticoagulant drugs (such as piperazine ferulate tablets), and aldosterone-inhibiting drugs (such as spironolactone), etc., they also have certain protein-lowering effects. If you choose to use it in conjunction with the condition, the effect of reducing protein will be better.

Simultaneously published with the WeChat public account of the same name “Kidney First”, the article is original by Zhou Xun and cannot be reproduced without authorization.