There is a tendency for some physicians to become alarmed by these fluctuations, particularly if a patient has kidney disease. However, for the vast majority of patients these test results are an expected part of the healing process. In fact, a wide range of research shows that olmesartan is therapeutic for kidney disease.
Subclinical - that is to say, undetected or undetectable - kidney disease is common in patients with Th1 diseases, and this is no less true of MP patients. Inflammation in the kidney and liver tend to be “silent.” Before beginning the MP, the kidneys are inflamed because they are infected with the Th1 pathogens. Patients tend to be largely unaware of the problem because their immune system, which has been weakened by the pathogens, doesn’t kill enough of the pathogens to cause a rise in bacterial byproducts that would be picked up on a blood test.
Once patients activate the innate immune system with olmesartan and begin rapidly killing the Th1 pathogens thanks to the MP antibiotics, the resulting immunopathology causes a rise in bacterial death, the effects of which are finally high enough to show up on lab tests.
One study found that hemodialysis patients who had high serum values of urea nitrogen (BUN) were less likely to have the acute infection, Helicobacter pylori.1) This suggests that temporary markers of kidney stress such as BUN may correlate with a robust and successful immune response.
In a 2011 study appearing in Kidney International, Agarwal et al. gave 16 patients with chronic kidney disease daily doses of paricalcitol, an orally active vitamin D receptor activator.2) The vitamin D analog was stopped after four days, and measurements were continued for three. Researchers found that subjects' serum creatinine significantly increased at a rate of 0.010 mg/dl/day and urine creatinine at a rate of 17.6 mg/day. Researchers also found a small increase in blood levels of BUN.
In conclusion, VDR activation may alter creatinine metabolism. An increase in creatinine generation may lead to an increase in serum creatinine and, if eGFR is used to measure kidney function, it may give the appearance that kidney function is declining when truly it may not be altered.
Rajiv Agarwal et al.
Typically, the levels of BUN - a measure of the amount of nitrogen in the blood that comes from urea, a substance removed by the kidneys - to come back elevated, as bacterial endotoxins cause nitric oxide and subsequently more nitrogen to be generated in the inflamed tissues. Levels of creatinine - a breakdown product of phosphate that is filtered by the kidneys - may also become elevated after people start the MP. This is not unusual, as most short courses of antibiotics aimed at killing classical bacteria also cause spikes in BUN and creatinine. According to the study site, maintaining a level of creatinine 10-20% higher than normal indicates the kidneys are functioning adequately while the MP is inducing immunopathology to resolve kidney inflammation.
The important thing to keep in mind is that these markers fall back into range as the disease resolves and the Th1 pathogens are eradicated. Remaining on olmesartan despite fluctuations in markers of kidney and liver function is therapeutic and a necessary part of the healing process.
In the patient with an increase in serum creatinine concentration, decreasing the dose of [the ARB]… will cause the serum creatinine concentration to return to the original baseline. Unfortunately, such an approach is not optimal for the long-term preservation of renal function and should be discouraged.
Biff Palmer, Nephrology at the University of Texas Southwestern 4)
According to a 2008 commentary appearing in Nature:
Vitamin D receptor (VDR) activation has a beneficial influence on the progression of experimental renal insufficiency, and reduced renal tissue renin expression may play a role in this process.
Ilkka H. Pörsti 5)
MP patients with kidney inflammation and their healthcare practitioners should be extremely comforted by the fact that the patient is taking olmesartan. This is due to the great number of studies, which have found that olmesartan and other ARBs protect the kidneys from the effects of inflammation and cytokine damage.
The benefits of olmesartan on patients with kidney inflammation include:
High-dose ARB treatment in patients with chronic renal disease is not associated with any clinically significant long-term negative effects on serum creatinine or potassium and is thus an important therapeutic modality with which to achieve further reductions in urinary protein excretion.
Alan J. Weinberg, et al. 15)
The effects of ARBs, in general, on people with kidney inflammation include:
Olmesartan also has additional beneficial effects for organs and system beyond the kidneys.
Caution for severe dehyration should be included. — Ken Collerman 07.09.2009
“Elevations in serum creatinine with RAAS blockade: why isn't it a sign of kidney injury?” http://www.ncbi.nlm.nih.gov/pubmed/18695383
Kidney Blood Press Res. 2011 Jun 28;34(6):418-423. [Epub ahead of print] Olmesartan Induces Renoprotective Effects by Stimulating Angiotensin Type 2 Receptors and Reducing Oxidative Stress in Diabetic Nephropathy.
Jo F, Morimoto S, Nakahigashi M, Kusabe M, Someya K, Morita T, Jo H, Imada T, Kosaki A, Toyoda N, Nishikawa M, Iwasaka T. Source
Second Department of Internal Medicine, Kansai Medical University, Moriguchi City, Japan.
Background: Angiotensin receptor blockers reduce the progression of diabetic nephropathy primarily by inhibiting angiotensin type 1 (AT(1)) receptors. In the present study, we investigated the role of angiotensin type 2 (AT(2)) receptors on the renoprotective effects of olmesartan in diabetic nephropathy. Methods: Six-week-old mice were treated with streptozotocin and divided into four groups: the OLM group (mice treated with olmesartan), the OLM+Ang II group (mice treated with olmesartan and angiotensin II), the OLM+PD group (mice treated with olmesartan and the AT(2) antagonist PD 123319), and the vehicle group. Nondiabetic mice were used as controls. We measured blood glucose levels and urinary excretions of albumin and 8-hydroxy-2'-deoxyguanosine (8-OHdG), which is a marker for oxidative stress. Results: Although urinary albumin excretion in the OLM and OLM+Ang II groups showed a tendency to be reduced compared to the vehicle group, it was significantly lower compared to the OLM+PD group. Urinary excretion of 8-OHdG was also significantly lower in the OLM and OLM+Ang II groups compared to the OLM+PD group. Conclusions: In diabetic nephropathy, the renoprotective effects of olmesartan are due not only to the blockade of AT(1) receptors, but also to a reduction in oxidative stress via stimulation of AT(2) receptors.
Copyright © 2011 S. Karger AG, Basel.