Long-Term Enalapril and Hydrochlorothiazide in Radiation Nephritis

Abstract

Radiation of the kidney often leads to renal failure. The contribution of arterial hypertension to the development of this complication is unclear. The aim of this study was to determine the renal effects of antihypertensive therapy in 1- and 2-kidney rat models of radiation nephritis. Five groups of Long Evans rats had X-irradiation of the left kidney. In groups 1 and 2, the right kidney was left undisturbed (2-kidney model). The rats in group 3, 4 and 5 underwent right nephrectomy 21 days before radiation (1-kidney model). Groups 1 and 3 received no drug treatment and served as controls for each model. Groups 2 and 4 had enalapril 50 mg/l in drinking water and group 5 hydrochlorothiazide (HCT) 200 mg/l, also in drinking water. Blood pressure increased significantly in both control groups and remained normal throughout the study in all treated groups. At the end of the study, mean urinary protein excretion was lower in the two enalapril-treated groups but not in HCT-treated animals. Groups 1 and 2 (2-kidney models) showed similar increments in plasma creatinine (P_creat), and, in both groups, the creatinine clearance (C_Creat) dropped to the same extent. Among nephrectomized animals (1-kidney model), P_creat was lower and C_Creat higher in the enalapril-treated group. Consistent with these findings, glomerular sclerosis was less severe in both enalapril-treated groups. We conclude that, in radiation nephritis, lowering blood pressure with enalapril exerts a beneficial effect on renal function and structure, whereas a similar reduction in blood pressure induced by HCT does not.

Chronic Kidney Disease in Long-Term Survivors of Hematopoietic Cell Transplantation

“…In addition, when it did occur, the onset of renal dysfunction was delayed and there was a decrease in proteinuria. Studies that have used ACEI in combination with dexamethasone (90) or ACEI with hydrochlorothiazide (91) or an angiotensin receptor blocker (ARB) had similar results. There was greater preservation of renal function with the ACEI and dexamethasone in combination, supporting the contributory role of inflammation in the process.…”

Bone Marrow Transplant Nephropathy: Radiation Nephritis Revisited

“…Whether ACE inhibitors are truly preferentially effective in human BMT NP is not known. Experimentally, ACE inhibitors are particularly effective in both prevention and treatment of renal radiation injury [45][46][47]. In other experimental models of renal disease, ACE inhibitors are preferentially effective in slowing the course of decline in kidney function [48][49][50], and this is true in some human kidney diseases as well [51][52][53].…”

RETRACTED: Role of renin-angiotensin-aldosterone system inhibitors in radiation nephropathy

“…Five reports 5,6,[8][9][10] including six comparisons were included in this meta-analysis of the BP level between the RAAS inhibitors group and the RD group. The p value of heterogeneity test was less than 0.00001 and a random-effects model was conducted.…”