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Böbrek Hastalıklarının Tedavisinde Anjiyotensin Dönüştürücü Enzim İnhibitörleri ve Anjiyotensin II Reseptör Blokerlerinin Kombinasyonu

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Abstract (Original Language): 
Renin-anjiyotensin sistemi (RAS) akut sistemik ve kronik lokal etkileri nedeniyle, renal ve kardiyovasküler hastalıkların oluşumunda önemli rol oynamaktadır. Bu sistemin anjiyotensin dönüştürücü enzim inhibitörleri (ACEl) ve/veya anjiyotensin II (A II) reseptör bloker-leri (ARB) ile süpresyonunun çeşitli kardiyovasküler ve renai bozuklukların düzeltilmesinde etkili olduğu kanıtlanmıştır. Son çalışmalara göre ARB'ler de en az ACEl kadar, hipertansiyon, kalp yetmezliği ve diyabetik nefropati tedavisinde etkili bulunmuşlardır. ACEl tedavisi sırasında bradikinin ve anjiyotensin 1-7 seviyelerinde artma görülmektedir. ARB'ler ise A II seviyelerinde artışa neden olarak A II tîp 2 reseptör stimülasyonuna neden olurlar. ARB'lerin ACEİ'lere göre en önemli klinik avantajı, öksürük ve anjiyoödem gibi yan etkilerinin olmamasıdır. Serum kreatinin seviyesinde progresif artış ve hiperkale-mi oluşması tedavinin sonlandırılması için bir endikasyon oluşturursa da, daha önceden bilinen renal hasarı olan hastalarda küçük, sta-bil artışlar tedavi sonlandırılmasını gerektirmez. ACEl ve ARB'lerin birlikte kullanımı kan basıncı regülasyonunda, kalp yetmezliği ve diyabetik nefropati tedavisinde tek başına kullanımına göre daha fazla avantaj sağlayabilmektedir.
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