| Objective: To investigate the clinical efficacy and safety of angiotensin II receptor antagonist valsartan in the treatment of patients suffering from acute exacerbation of chronic kidney disease combined with malignant hypertension.Methods: 24 cases of patients diagnosed of acute exacerbation of chronic kidney disease combined with malignant hypertension who were admitted into the Department of Nephrology,the Affiliated Hospital of Medical College of Qiingdao University,from December 2012 to December 2016,and followed up for more than 4 months,were retrospectively analyzed and researched.Valsartan and other antihypertensive drugs were used to control blood pressure,and the initial dose of valsartan was 80-160mg/d,with the maximum dose of 320mg/d,and the target of blood pressure control was set to be 140/90 mm Hg.When the therapeutic dose was reached,the changes in blood pressure,serum creatinine,24 h urine protein,hemoglobin,serum potassium and other indicators before treatment and 2 weeks,4 weeks,8 weeks and 4 months after treatment were compared,to observe the clinical efficacy and safety of valsartan in the treatment of patients suffering from acute exacerbation of chronic kidney disease combined with malignant hypertension.Results: among all collected cases,10 suffered from malignant hypertension secondary to chronic glomerulonephritis,12 from primary malignant hypertension combined with renal damage,and 2 from diabetic nephropathy-induced malignant hypertension,among whom 5 cases met diagnosis criteria of hemolytic uremic syndrome.Serum creatinine,urea nitrogen,urinary protein,serum potassium,hemoglobin,platelet,serum sodium,chloride,carbon dioxide combining power and other indicators of these patients before treatment and 2 weeks,4 weeks,8 weeks after treatment and at the end of 4 months were collected.Hemoglobin,platelets and other indicators were significantly improved after treatment,P<0.05,indicating the differences had statistical significance.In terms of the changes of electrolyte,4 cases of patients presented slight elevation of serum potassium after 2-4 weeks of treatment,and were maintained at the normal levels after 4-8 weeks of treatment by limiting high potassium diet and intermittent administration of diuretics;8 cases of patients presented metabolic acidosis before treatment,and were maintained at the normal levels after the administration of acid suppression drugs for 2 weeks;serum sodium and chloride levels showed no significant changes before and after treatment,P>0.05,indicating the changes were not statistically significant;Blood pressures of patients were observed by referring to blood pressure control target,to judge blood pressure control rate.The results showed that blood pressure control rate was lower than 3.8%(1/26)at the second week,the average decline in blood pressure had statistical significance after treatment,P<0.05;systolic blood pressure control rate was lower than 7.7%(2/26)at the end of the fourth week,the average decline in blood pressure had statistical significance after treatment,P<0.05;systolic blood pressure control rate was 54.2%(13/24)and diastolic blood pressure control rate was 45.8%(11/24)at the end of the eighth week,the average decline in blood pressure had statistical significance after treatment,P<0.05;the systolic blood pressure control rate was 50%(12/24)at the end of the fourth month,the average decrease in blood pressure had statistical significance after treatment,P<0.05,and showed no statistical significance compared with after 8 weeks of treatment,p>0.05;the diastolic blood pressure control rate at the end of the fourth month was 41.7%(10/24),the average reduction in blood pressure had statistical significance after treatment,P<0.05,showed no statistical significance compared with after 8 weeks of treatment,p>0.05;The urine protein levels of the patients included into the study were observed,and the control rate was evaluated by referring to decrease level of urine proteins,and effect of valsartan-based treatment to patients with different primary diseases was compared by individual analysis.The results showed that the urine protein level decreased significantly at the end of the second week and thereafter,P<0.05,indicating the difference was statistically significant.The urine protein level of the group with diabetic nephropathy as primary disease did not decrease significantly,P>0.05,suggesting that there was no statistical significance;and groups with malignant hypertension and chronic glomerulonephritis as primary diseases decreased significantly,P<0.05,showing the difference was statistically significant.The serum creatinine and urea nitrogen of patients were observed,and the therapeutic effect was evaluated by reference to the decrease level.The results showed that the level of serum creatinine and urea nitrogen decreased at the end of the eighth week and thereafter,P<0.05,indicating the changes were statistically significant;Safety analysis: in the course of treatment,4 cases presented slightly elevated serum potassium after 2-4 weeks of treatment,and were maintained at the normal levels after 4-8 weeks of treatment by limiting high potassium diet and intermittent administration of diuretics;2 case presented transient dizziness,1 case felt oral metallic taste,and the rest did not present pathological hyperkalemia,elevated creatinine,dizziness,headache,nausea,coughing and other adverse reactions.Conclusion: 1.For patients suffering from acute exacerbation of chronic kidney disease with malignant hypertension,ARB medication like valsartan is relatively safe.However,to accomplish anti-hypertension objectives,other antihypertensive drugs shouble be combined.The antihypertensive effects have no significant correlation with quantities of drug combinations.2.Through controlling blood pressure and proteinuria,valsartan can remove acute exacerbation factors and relieve renal functions.3.Valsartan plays the role of kidney protection through hemodynamic and non-hemodynamic effects.4.Compared with ACEI drugs,ARB medication has better compliance.5.The therapeutic schedules based on valsartan for different primary patients have different turnovers,among which primary malignant hypertension and glomerulonephritis are better than diabetic nephropathy. |
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