Effect of Selective COX-2 Inhibitor on Proteinuria in Diabetic Patient Treated with ACE Inhibitor

Chung, Jin Ook; Hong, Se In; Yoon, In Seok; Cho, Dong Hyuk; Kang, Ho Cheol; Chung, Dong Jin; Chung, Min Young

Abstract

The proteinuria in the diabetic patients is a risk factor of developing cardiovascular disease, and also diabetic nephropathy is a leading cause of end stage renal disease. Therefore, much efforts have been concentrated on controlling microalbuminuria to prevent cardiovascular disease and to retard the progression of diabetic nephropathy. Angiotensin converting enzyme (ACE) inhibitors are known to play a role in controlling the blood pressure and reducing proteinuria. This study aims to ascertain the additive effect of selective cycloocygenase-2 (COX-2) inhibitor in patients with diabetic nephropathy treated with ACE inhibitor. Sixty seven subjects were selected among patients with diabetic nephropathy who had been treated with lisinopril over 8 weeks. They were divided into 4 groups of 12-24 subjects, and 2 groups received lisinopril daily dose of 10 mg (L10) or 20 mg (L20), whereas the other two groups received 15 mg/day meloxicam in addition to 10 mg/day lisinopril (L10 + M15) or 20 mg/day (L20 + M15). After 2 weeks, proteinuria significantly decreased in all 4 groups; however, the magnitude in the decrease was significantly greater in the combination groups than in the groups which received lisinopril only. But, no significant difference was noted between the lisinopril doses. The creatinine clearance rate tended to be more reduced in groups with combination therapy than with monotherapy. These results suggest an additive antiproteinuric effect of selective COX-2 inhibitor meloxicam and ACE inhibitor lisinopril. However, since there seems to be a possibility of hyperkalemia and impairment of renal function in combination therapy, more extensive studies should be undertaken.