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A diuretic, spironolactone, is often used in nephrology. It can help kidney patients reduce proteinuria by more than 50%.

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Spironolactone Can Reduce Proteinuria by More than 50%

2019-01-29 15:16

Spironolactone Can Reduce Proteinuria by More than 50%A diuretic, spironolactone, is often used in nephrology. We use spironolactone less alone and often in combination with other diuretics. Kidney patients who have had edema may know it.

If you think spironolactone can only be used as a diuretic and blood pressure reducer, you're underrating it. I'm going to talk to you today about what it does for chronic kidney disease -- it lowers urinary protein.

Spironolactone can reduce proteinuria.

In addition to being a diuretic, spironolactone has an identity as a mineralocorticoid receptor antagonist, or aldosterone antagonist.

What is mineralocorticoid receptor antagonist?

Nephropathy attack→ renin →angiotensin 1 →angiotensin 2→aldosterone→mineralocorticoid receptors → intraglomerular hypertension → glomerular sclerosis → renal failure.

In simple terms, spironolactone blocks this pathway.

In patients with kidney disease, aldosterone is often excessive. Spironolactone blocks the increase of aldosterone so that the glucocorticoid receptor can be protected from the stimulation of aldosterone so as to reduce renal injury, reduce urinary protein and protect renal function.

Another well-known class of blood pressure drugs, ACEI/ARBs, called angiotensin inhibitors, have a similar effect on inhibiting this process.

Kidney patients suitable for spironolactone deproteinization: chronic kidney disease with mild or moderate proteinuria, 24-hour urinary protein quantification is more than 0.5g, especially for patients with more than 1g, including IgA Nephropathy, Nephritis Syndrome, Lupus Nephritis, Purpura Nephritis and Diabetic Nephropathy.

Steroids and other immunosuppressive agents can be considered in 24-hour proteinuria and Nephrotic Syndrome patients with more than 3.5g of urinary protein.

How is the effect of spironolactone on urinary protein?

If spironolactone is used to reduce urinary protein, the dose should be 20-40mg daily, taken once in the morning. Usually it will take effect 4 weeks later, and the longer the use time, the more obvious the effect. It can be taken for a long time.

A recent study showed that in kidney patients who had 24 hours of urinary protein greater than 1g, the urinary protein decreased by 61% after 1 month of spironolactone administration.

Patients with more than 1g of 24-hour urine protein and a risk of progression to chronic renal failure are often found. After the use of spironolactone, the urine protein is reduced to less than 0.5g, reaching clinical cure.

Contraindications and precautions

Spironolactone can reduce blood pressure, increase blood potassium, and reduce glomerular filtration rate, so patients with low blood pressure, hyperkalemia, chronic kidney disease stage 4-5 (blood creatinine is over 442) can not use it.

Spironolactone users should pay attention to the monitoring of blood pressure, electrolytes and blood creatinine indicators.

The most important thing to note is hyperkalemia. Spironolactone is a potassium-sparing diuretic, so it is very dangerous for patients with high blood potassium. Normal blood potassium is 3.5--5.5 mmol/L. When it is more than 6.5 mmol/L, it will have the possibility of cardiac arrest. If excessive potassium is found during the use of spironolactone, discontinue immediately.

Blood creatinine may increase slightly in the early stage of treatment. This is a temporary effect of spironolactone on hemodynamics. It will not damage the kidney. Long-term administration of spironolactone can help alleviate the decrease of glomerular filtration rate and stabilize blood creatinine in renal failure patients with blood creatinine below 442.

Kidney patients can use the spironolactone under the guidance of doctors. For more information on proteinuria treatment, please leave a message below or contact online doctor.

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