title: Successful effect of triple blockade of renin-angiotensin-aldosterone system on massive proteinuria in a patient with chronic kidney disease.
abstract: A patient with chronic kidney disease (CKD) due to membranous nephropathy with daily urinary protein excretion exceeding 5 g did not respond well to dual therapy with an angiotensin converting enzyme inhibitor (ACE-I) and angiotensin II receptor blocker (ARB). Addition of the mineralocorticoid receptor blocker (MRB), spironolactone, led to moderate reduction in daily urinary protein excretion. However, spironolactone had to be inevitably discontinued due to gynecomastia. Replacement of spironolactone with the selective MRB, eplerenone, added to the preceding treatment with ACE-I and ARB, resulted in remarkable reduction of daily urinary protein excretion to less than 0.2 g. This case suggests that triple blockade of renin-angiotensin-aldosterone (RAA) system with ACE-I, ARB, and MRB could be useful for CKD patients with massive proteinuria.
authors.affiliation: Division of Nephrology, Saiseikai Central Hospital, Minato-ku, Tokyo, Japan. kuriyamas218@yahoo.co.jp
authors.forename: Satoru
authors.initials: S
authors.lastname: Kuriyama
authors.forename: Naoki
authors.initials: N
authors.lastname: Sugano
authors.forename: Hiroyuki
authors.initials: H
authors.lastname: Ueda
authors.forename: Yasushi
authors.initials: Y
authors.lastname: Otsuka
authors.forename: Go
authors.initials: G
authors.lastname: Kanzaki
authors.forename: Tatsuo
authors.initials: T
authors.lastname: Hosoya
mesh_terms: D047228:Angiotensin II Type 1 Receptor Blockers / Q000627:therapeutic use; D000806:Angiotensin-Converting Enzyme Inhibitors / Q000627:therapeutic use; D000077545:Eplerenone; D015433:Glomerulonephritis, Membranous / Q000188:drug therapy*; D006801:Humans; D007676:Kidney Failure, Chronic / Q000188:drug therapy*; D008297:Male; D008875:Middle Aged; D000451:Mineralocorticoid Receptor Antagonists; D011507:Proteinuria / Q000188:drug therapy*; D012084:Renin-Angiotensin System / Q000187:drug effects*; D013148:Spironolactone / Q000031:analogs & derivatives
chemical_list: D047228:Angiotensin II Type 1 Receptor Blockers; D000806:Angiotensin-Converting Enzyme Inhibitors; D000451:Mineralocorticoid Receptor Antagonists; D013148:Spironolactone; D000077545:Eplerenone