Estudio prospectivo, aleatorizado, controlado para evaluar la eficacia de la utilización precoz de losartán y/o espironolactona en pacientes con trasplante renal sobre la reducción de tgf-ß1 en plasma y su papel en la regresión de hipertrofia ventricular izquierda y la prevención de nefropatía crónica del trasplante renal

Zusammenfassung

Left ventricular hypertrophy is a very common pathology in chronic kidney disease and dialysis patients, causing significant morbidity and mortality. The main cause of death in the transplant is cardiovascular, left ventricular hypertrophy being a risk factor for the same, so as to sudden death. There are not clear evidence of improvement of this pathology after transplantation. Actually chronic allograft nephropathy (CAN) is the main cause today of loss graft, leads inexorably to renal graft failure and patient step back to dialysis. This damage occurs early with renal interstitial fibrosis and tubular atrophy among others. The aim of this work is to test a therapeutic strategy in recent transplanted with inhibitors of angiotensin II receptor (Losartán, ARBs), aldosterone antagonists (spironolactone) or the combination of both and study the effect on serum levels of TGF beta 1 cytokine. TGF has been shown clearly involved in the development of CAN and probably in the perpetuation of low myocardial remodeling and left ventricular hypertrophy. Also, it has been observed in numerous studies that the occurrence data fibrosis in renal parenchyma is very early, even in the first year after transplantation, so early action with drugs that have shown evidence of action at this level could avoid the development of this damage. This research could help to treat and / or prevent chronic allograft nephropathy and left ventricular hypertrophy after transplantation. We carry out a prospective clinical trial with 3 groups of patients newly transplanted (plus control group) where pharmacological intervention is performed with losartan, spironolactone or a combination of both. We will make a prospective follow-up of patients during 2 years with measurement of echocardiographic parameters, markers of renal function and damage, as well as monitoring of plasmatic TGF beta1.