Puli and sartan have the effect of protecting kidney, but people with poor renal function should use drugs carefully.
thereby lowering blood pressure.But it should be noted that Puli and sartan cannot be used in combination..II. Renal protective effects of Pril and sartan.Pril and sartan can lower blood pressure.Improve the state of high pressure,
An old friend told Huazi that he had high blood pressure and his kidney function was not very good, and he had been taking drugs like Pril to protect his kidneys, but someone told him that drugs like Pril could also harm the kidneys. He was a little worried. Would you like to switch to Satan drugs?.
Huazi saidPril drugs are angiotensin 2 converting enzyme inhibitors and sartan drugs are angiotensin 2 receptor antagonists.The pharmacological mechanisms of the two are similar.Both reduce blood pressure by inhibiting the renin-angiotensin-aldosterol system (RAAS), so the effects on the kidneys are similar.
Angiotensin 2 has a great effect on blood pressure.
Renin secreted by juxtaglomerular organ cells will be converted into angiotensin 1, 2, 3 under the action of a series of biological enzymes. 7, of whichAngiotensin 2 (Ang2) has the strongest effect on blood pressure.Can cause systemic arterioles and veins to contract, increase blood volume in the heart, and increase blood pressure.
Angiotensin 2 can also increase sympathetic excitability, increase aldosterone release, lead to sodium ion and water retention, increase potassium ion excretion, and increase blood pressure.
Pril can reduce the production of angiotensin 2, and sartan can prevent angiotensin 2 from binding to the corresponding receptors in blood vessels, thereby lowering blood pressure.But it should be noted that Puli and sartan cannot be used in combination..
II. Renal protective effects of Pril and sartan.
Pril and sartan can lower blood pressure.Improve the state of high pressure, high perfusion and high filtration in glomeruliIt can improve the permeability of glomerular filtration membrane and significantly reduce urinary protein. AndThere are also blood pressure independent effects.It can reduce the accumulation of renal extracellular matrix and antagonize glomerulosclerosis and renal interstitial fibrosis.
Therefore, patients with kidney disease, regardless of whether they have hypertension or not, as long as there are no contraindications, they can use Puli or sartan to protect their kidneys. In related clinical trialsThe evidence for the protection of kidney by Puli is more abundant.Therefore, in the treatment, we usually choose Pril first. ButPripril drugs are prone to adverse reactions of dry cough. If they are unbearable, they can be replaced by sartan..
Third, the effect on the kidney is a "double-edged sword".
The number of angiotensin receptors in the efferent arteriole of the kidney is significantly higher than that in the afferent arteriole, soThe dilatation effect of Puli and sartan on efferent arterioles is stronger than that on afferent arterioles.This difference helps to reduce glomerular pressure, but alsoIt can decrease renal blood perfusion and glomerular filtration rate..
When used for a long time, Puli and sartan have a good protective effect on the kidney. ButPatients with renal insufficiency may have an increase in serum creatinine or even acute renal failure in the first 2 months of using Pril and sartan.Therefore, the effect of this kind of drugs on patients with renal insufficiency is also known as "double-edged sword".
4. Patients with renal insufficiency should use drugs cautiously
Puli and SatanPeople with allergies, pregnancy and lactation should be prohibited.Patients with bilateral renal artery stenosisAfter medication, it may cause glomerular perfusion pressure deficiency and lead to acute renal injury, alsoNeed to disable.
Drugs can be used in patients with renal insufficiency and unilateral renal artery stenosis, but start with a low dose, andPay close attention to the changes of serum creatinine 2 months before treatment, and detect them every 1 to 2 weeks.. Prednisone and sartan reduce the release of aldosterone, resulting in an increase in serum potassium. On the other hand, the ion regulation ability of patients with renal insufficiency is weakened, soSerum potassium should be detected at the same time..
If the increase in serum creatinine is less than 30% as normal, you can continue to use the drug; if the increase in serum creatinine is between 30% and 50%, you need to reduce the dose and continue to observe, and stop taking the drug if necessary;The increase of serum creatinine is more than 50%, and the drug needs to be stopped.. If it is found during the period of medicationThe serum potassium is higher than 5.5mmol/L, and the drug should be stopped..
Diuretics are also commonly used antihypertensive drugs, through the discharge of sodium, drainage to play a role in reducing blood pressure, but in the discharge of sodium ions will also discharge potassium ions, which will cause a decrease in blood potassium.Diuretics can be used in combination with Pril or sartan to complement and reduce the effect of serum potassium.. ButDiuretics may cause an abnormal increase in serum creatinine after reducing blood volume.Therefore, it is necessary to reduce the dosage in the combination of drugs.
To sum up, Pril and sartan are commonly used antihypertensive drugs, which have a protective effect on the kidney when used for a long time. However, for patients with renal insufficiency, it may be a "double-edged sword", and acute renal injury may occur at the initial stage of medication, so it should be used cautiously from a small dose and gradually increase the dose.
Drugs should be used under the guidance of a doctor. If you have any doubts about the use of drugs, please consult your doctor or pharmacist. I am Huazi, a pharmacist. Welcome to follow me and share more health knowledge.