Effect Of ACEI On Renal Function In Elderly Patient With Unilateral Atherosclerotic Renal Artery Stenosis

An epidemiological screening showed that the average age of 77 yearsin the population, the renal artery stenosis (stenosis>60%) prevalence rate was 6.8%.Autopsy found that 27% of patients over 50 years suffered RAS(stenosis≥50%).There is 10.15% of kidney dialysis patients develop to endstage renal disease due to RAS. There are 25% of renal dysfunction in el-derly patients, associated with undiagnosed RAS. In adults, RAS is mainlyatherosclerosis caused. In western countries, 90% of the RAS is caused byatherosclerosis, whereas 72% of our country. If other organizations vessels (cerebral, coronary and peripheral vascular) suffer atherosclerosis, the occur-enceof an increased likelihood of RAS. The atherosclerotic renal artery ste-nosis(ARAS)mainly secondary tohypertension, proteinuria, severe cases can lead to end-stage renal disease.Angiotensin converting enzyme inhibitor (ACEI)in the main mechanismfor the inhibition of the renin angiotensin aldosterone system (RAAS) and kallikrein-kinin system (KKS), this in double system produced by a varietyof vasodilators, antiproliferative, antithrombotic and anti-fibrosis synergistic, antagonistic too increased angiotensinâ…¡(Anglotenslnâ…¡, Angâ…¡) of the har-mful effects, thereby protecting target organs. Hou Fanfan's ESBARI such studies in China show that the high tissue affinity angiotensin converting enzyme inhibitors can reduce the advanced chronic kidney disease patients developed end-stage renal failure to the risk that the only buck Baohu bot-h through kidneys, but also by other ways to improve the renal lesions, r-educe proteinuria drugs. So far, in improving endothelial function, angiote-nsin converting enzyme inhibitors are best than other antihypertensive drug-s (diuretics,βblockers, calcium antagonists).The results also suggested thatthe angiotensin converting enzyme inhibitors in improving the prognosis ofpatients the outstanding position, especially in patients with multiple athero-sclerotic disease in elderly patients is more respected.For bilateral RAS or solitary kidney renal artery stenosis, ACEI is ab-solutely contraindicated. Unilateral RAS patients narrowkidneys perfusion p-ressure decline, plasma renin elevated, Angâ…¡increase systemic vasoconstr- iction aroused hypertension, hypertension acting on contralateral kidney, thr-oughpressure diuresis make sodium excretion increase. However, Angâ…¡in-crease, its vasoconstriction reduce contralateral renal blood reduce GFR, in-fluence on adrenal cortex, promote aldosterone generate, promoting water sodium reabsorption above role and contralateral renal pressure diuretic eff-ects offset, water sodium balance rely system hypertension generated diure-tic role maintain, using ACEI treatment, although stenosis kidneys blood f-low reduce, GFR declined, contralateral kidney blood flow increased, GFR increase, application ACEI can effectively control blood pressure, prevent concurrency disease. However, it is controversial that whether angiotensin converting enzyme inhibitors should be used in unilateral atherosclerotic re-nal arterystenosis patients, because there are reports that angiotensin converting enzyme inhibitors in some cases cause severe renal insufficiency, littleresearch at home and abroad. Benazepril ( Lotensin? ) is typical of ACEI class of drug, it almost has all the benefits of ACEI drugs, and the low incidence of side effects, especially kidney protective effect , so this paper regard Lotensin? as ACEI representative to explore its unilateral atheroscle-rotic stenosis of renal artery in renal function in elderly patients.Objective:ACEI observed in unilateral atherosclerotic renal artery ste-nosis (ARAS) of renal function in elderly patients, to explore an effective drug for treatment of unilateral ARAS.Methods:Based on the clinical manifestations and results of screeningrenal arteriography in patients with a total of 115 cases of unilateral ARA-S divided into Lotensin? group of 55 patients and non-ACEI group of 60-cases.Record the baseline blood pressure,Scr,in order to calculate glomerularfiltration rate (GFR) with CKD-EPI formula, record the N-acetyl-β-glucosa-minidase (NAG) on admission. The first month of follow-up bi-weekly, on-ce every three months thereafter, measurement of blood pressure, serumpot-assiumtests, Scr, and calculate the GFR, patients were compared changes inrenal function during follow-up.Results:The basis of information the two groups was no significant difference (P> 0.05). During the average follow-up 15 months, Lotensin? group is better than non-ACEI group in antihypertensive effect (P<0.05). Compared with baseline, Lotensin? group is no significant changes in GFR[(80.73±16.707)ml·min^-1·(1.73m²)^-1vs(81.06±12.231)ml·min^-1·(1.73m²)^-1,P>0.05];ACEI group GFR decreased significantly[(81.49±14.486)ml·min^-1·(1.73m²)^-1比(79.84±14.648)ml·min^-1·(1.73m²)^-1,P<0.01]. To observe the end of the non-ACEI group GFR less than Lotensin? group[(79.84±14.648)ml·min^-1·(1.73m2)^-1比(81.06±12.231)ml·min^-1·(1.73 m²)^-1,P<0.05]. Non-ACEI group GFR de-creased rate (â–³GFR%) was significantly higher than Lotensin? group(-9.694%±5.994%比0.261%±8.255%,P<0.01). Correlation analysis showed that ba-sed on GFR, NAG withâ–³GFR% was significantly correlated (Pearson pr-oduct correlation coefficients were from 0.573, -0.472, P<0.01).Conclusion:1. Using ACEI in the treatment of hypertension caused by un-ilateral ARAS, that the antihypertensive effect is ideal, and the renal func-tion has no significant changed. It is recommended to prefer ACEI in the treatment of ARAS with kidney function monitoring. 2. In the treatment ofhypertension caused by unilateral ARAS, ACEI is superior to other antihy-pertensive drugs. 3. NAG is the most sensitive indicators to assessment theearly renal damage, it is recommended to check it in kidney patients who-se Scr and BUN are no changed to guard against the kidney disease with no clinical symptoms and signs. 4.For patients with unilateral ARAS, whentheir NAG are abnormal, which prompted the early renal damage, applicat-ion of non-ACEI class of antihypertensive drugs can cause decreased kidn- ey function, so applications should carefully.