March 27, 1997
A common antifungal drug may buy precious time for people with three chronickidney diseases, delaying their need for dialysis or transplantation, a Johns Hopkins studyshows.
The drug, which may promote healing of kidney damage by reducingoverproduction of the body's main steroid hormone, could substantially reduce the risk,cost and inconvenience associated with dialysis and transplantation, says MackenzieWalser, M.D., lead author and a professor of pharmacology, molecular sciences andmedicine.
"Our findings are early but promising, and point to a new, long-term approachthat may be safe and effective for treating these three types of chronic kidney disease,"says Walser, adding that further studies are needed.
Results of the study, supported by the National Institutes of Health and JanssenPharmaceutica, are published in the April issue of the American Journal of KidneyDiseases.
Researchers studied 20 patients who had one of four types of chronic kidneydiseases: glomerular disease, interstitial nephritis, diabetic nephropathy or polycysticdisease. The patients were treated with a well-known antifungal drug called ketoconazolefor one to four years.
The treatment slowed disease progression by 66 percent in patients withglomerular disease, 55 percent in those with interstitial nephritis and 77 percent in those with diabetic nephropathy. However, the disease rate accelerated by 99 percent in patientswith polycystic kidney disease.
In two patients, the treatment continued to slow progression of glomerular diseasefor four years. Ketoconazole caused some side effects, primarily liver problems, thatoften occur when it is used to treat fungus infections. Treatment was stopped in threepatients because of side effects, and the patients recovered quickly.
Ten years ago, Walser and his Hopkins colleagues found that chronic kidneydiseases progressed fastest in patients whose adrenal glands produced a large amount ofcortisol, the body's principal steroid hormone, and slowest in patients whose adrenalglands produced little cortisol. They speculated that reducing production of cortisol mightslow the progression of kidney failure by promoting the healing of injury to the kidneys.Researchers selected ketoconazole for the study because it has been shown to partiallysuppress cortisol production. Cortisol belongs to a group of hormones that control thebody's use of nutrients and the excretion of salts and water in the urine.
The study's co-author was Sylvia Hill, B.S.
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