Effect Of Calcitriol Combined With Valsartan In Treating Diabetic Nephropathy

Backgroud and Objective:Diabetic nephropathy is one of the serious chronic diabetic complications. The emergence of urine albumin is the main symptoms in clinical. For the treatment of diabetic nephropathy emphasizes the control blood sugar, blood pressure, droping urinary protein and protecting kidney function. Drop urine protein is one of the most basic treatment. In the drop of urine protein treatment, ARBs is the first choice.In addition, many other drugs were found have a role to protect the kidney and reduce urinary protein, such as rhein, tripterygium wilfordii,etc. Therefore the combination drug therapy in treatment of diabetic nephropathy is increasingly wider. The combined treatment effect could be more better than monotherapy due to their different protection mechanism of kidney. At home and abroad studies have found that vitamin D in the treatment of diabetic nephropathy also can drop urine protein and improve blood glucose,blood pressure in patients. The purpose of this paper is to investigate whether active vitamin D(calcitriol) joint ARBs(valsartan) can more effectively reduce urinary protein compared with monotherapy and the effects on blood pressure, blood sugar, ion index change. Research Methods:64 patients of diabetes nephropathy diagnosed in The Third clinical medical school of Jilin University from December 2013 to March 2015 were selected as a subject of study. All of them were in accordance with the inclusive criteri, and were randomly divided into control group and observation group.Among them, 32 cases as the control group were only given valsartan(80mg/day), the course of treatrment was 6 months. Observation group have 32 people and they were given valsartan(80 mg/day) and calcitriol(0.5 ug/day), the course of treatment was 6 months. The changes of blood pressure, 24 h urine protein quantitative, serum creatinine(Scr), fasting plasma giucos(FPG), haemoglobin A1C(Hb A1c), serum potassium(K+), serum calcium(Ca2+)and serum phosphorus(P3+) were observed before and after treatment. All the statistical analysises were dealt with SPSS21.0 version software. And then to analysis the relationships of the indicators. Research Results :1. Blood pressure, 24 h urinary protein quantitative, Scr, FPG, Hb A1 c, K+, Ca2+, P3+ had no statistical difference(P > 0.05) in two groups before treatment.2. Compared with before treatment, patients with FPG, Hb A1 c, Scr, K+, Ca2+,P3+ had no statistical in two groups after 6 months treatment.3. SBP and DBP were all reduced significantly(P﹤0.001)compared with before treatment in each group.But there was no statistically significant(P > 0.05) between groups.4. 24 hours urinary protein quantitative were reduced significantly compared with before treatment in each group(P﹤0.001). And compared with valsartan group, the 24 hours urinary protein quantitative in combined treatment group reduced more significantly after 6 months, the difference was statistically significant(P﹤0.05). Two groups of patients had no serious adverse reactions. Conclusions:Valsartan combined with calcitriol can more effectively lower the urine protein in patients with diabetic nephropathy.