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An Association Of Losartan-Hydrochlorothiazide, But Not Losartan-Furosemide, Completely Arrests Progressive Injury In The Remnant Kidney

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Renal Physiology

Published online on

Abstract

We showed previously that an association of losartan and hydrochlorothiazide, initiated one month after 5/6 nephrectomy (Nx), reversed hypertension and albuminuria and promoted lasting renoprotection. In this new study, we investigated whether equal or even better protection can be obtained by combining losartan and furosemide. Nx was performed in 58 Munich-Wistar rats. One month later, tail-cuff pressure and albuminuria were markedly elevated. At this time, Nx rats were distributed among four groups: Nx (untreated); NxL, receiving losartan; NxLH, receiving losartan and hydrochlorothiazide; and NxLF, given losartan and furosemide. Seven months later, Nx rats exhibited high mortality, severe hypertension, albuminuria, glomerulosclerosis and interstitial fibrosis. Losartan treatment limited mortality and attenuated the renal and hemodynamic abnormalities associated with Nx. As shown previously, the LH association normalized TCP and ALB, prevented renal injury, and reduced mortality to zero. The LF treatment failed to reduce TCP or ALB to normal, and prevented renal injury less efficiently than the LH regimen. The reasons for the differing efficacies of the LF and LH schemes are unclear, and may include beneficial nondiuretic actions of thiazides, such as vasorelaxation and antiproliferative activity. These results refute the established concept that thiazides and thiazide-like diuretics are ineffective at advanced CKD stages. Rather, they suggest that, in view of their renoprotective action, these compounds may even be preferable to loop diuretics in the management of hypertension in advanced CKD.