Background The non-hemodynamic effects of angiotensin receptor blocker （ARB） in the delay of progression of chronic kidney disease （CKD） remain unclear. In this study, we investigated the influence of irbesartan on the urinary excretion of cytokines in patients with CKD. Methods In this randomized perspective clinical trial, different doses of irbesartan （150 mg/d and 300 mg/d） were given to two groups of patients in a cross-over design. Blood pressure （BP）, creatinine clearance （Ccr） and 24-hour proteinuria were examined. Urinary excretion of cytokines was determined by human inflammatory cytokine antibody array. A two-fold change in spot intensity was considered significant. Results Urinary excretion of cytokines （granulocyte colony stimulating factor （GCSF）, intercellular cell adhesion molecule-1 （ICAM-1）, interferon y （IFN-y）, interleukin 1β （IL-1β）, IL-2, IL-6, IL-8, IL-11, IL-15 and macrophage inflammatory protein 1δ （MIP-Iδ） in group B （irbesartan 300 mg/d） was significantly decreased in comparison to group A （irbesartan 150 mg/d） after 8-week treatment. In group A, 8 weeks of treatment induced a two- to nine-fold reduction in urinary cytokine levels （GCSF, GM-CSF, IFN-γ, IL-1α, IL-11, IL-12p40, MCP-2, MIP-1α）, while increasing the dosage to 300 mg/d further decreased the excretion of GCSF, GM-CSF, IL-12p40, MCP-2 and MIP-1α by week 18. There was no significant difference in BP or Ccr between the two groups. However, 24-hour proteinuria was significantly reduced in both groups, and in group A the reduction was dose dependent.Conclusion Irbesartan offers additional renoprotection in a dose-dependent manner by reducing pro-inflammatory cvtokines excretion in the urine of CKD patients.
Hyperuricemia(HUA)is a risk factor for chronic kidney disease(CKD).The relationship between HUA and white blood cell(WBC)count remains unknown.A sampling survey for CKD was conducted in Sanlin community in 2012 and 2014.CKD was defined as proteinuria in at least the microalbuminuric stage or an estimated GFR of 60 mL/(min·1.73 m2).HUA was defined as serum uric acid>420µmol/L in men and>360µmol/L in women.This study included 1024 participants.The prevalence of HUA was 17.77%.Patients with HUA were more likely to have higher levels of WBC count,which was positively associated with HUA prevalence.This association was also observed in participants without CKD,diabetes mellitus,hyperlipidemia,or obesity.Multivariate logistic regression analysis showed that WBC count was independently associated with the risk for HUA in male and female participants.Compared with participants without HUA,inflammatory factors such as high-sensitivity C-reactive protein,tumor necrosis factor-α,and interleukin 6 increased in participants with HUA.Hence,WBC count is positively associated with HUA,and this association is independent of conventional risk factors for CKD.
