Treatment of IgA nephropathy with ACE inhibitors: a randomized and controlled trial.

Abstract

Some retrospective studies have suggested a beneficial influence of angiotensin-converting enzyme (ACE) inhibitors on the progression of IgA nephropathy (IgAN), but prospective and controlled studies demonstrating this effect are lacking. Forty-four patients with biopsy-proven IgAN, proteinuria > or = 0.5 g/d, and serum creatinine (SCr) < or = 1.5 mg/dl were randomly assigned either to receive enalapril (n = 23) or to a control group (n = 21) in whom BP was controlled with antihypertensives other than ACE inhibitors. Primary outcome was renal survival estimated by a 50% increase in baseline SCr. Secondary outcomes were the presence of a SCr > 1.5 mg/dl at the last visit and the evolution of proteinuria. Baseline clinical findings were similar at baseline between enalapril-treated and control group, and there were no differences in BP control during follow-up. Mean follow-up was 78 +/- 37 mo in the enalapril group and 74 +/- 36 mo in the control group. Three patients (13%) in the enalapril group and 12 (57%) in the control group reached the primary end point (P < 0.05). Kaplan-Meier renal survival was significantly better in enalapril group than in control group: 100% versus 70% after 4 yr and 92% versus 55% after 7 yr (P < 0.05). Three patients in the enalapril group (13%) and 11 (52%) in the control group showed SCr > 1.5 mg/dl at the last visit (P < 0.05). Proteinuria significantly decreased in the enalapril group, whereas it tended to increase in the control group (P < 0.001 between groups). In conclusion, ACE inhibitors significantly improve renal survival in proteinuric IgAN with normal or moderately reduced renal function.

• Authors: Manuel Praga, Eduardo Gutiérrez, Ester González, Enrique Morales, Eduardo Hernández
• Journal: Journal of the American Society of Nephrology : JASN (J Am Soc Nephrol) Vol. 14 Issue 6 Pg. 1578-83 (Jun 2003) ISSN: 1046-6673 [Print] United States
• PMID: 12761258 (Publication Type: Clinical Trial, Journal Article, Randomized Controlled Trial)

Chemical References

• Angiotensin-Converting Enzyme Inhibitors
• Enalapril
• Creatinine

Topics

• Adult
• Angiotensin-Converting Enzyme Inhibitors (therapeutic use)
• Creatinine (blood)
• Enalapril (therapeutic use)
• Female
• Glomerulonephritis, IGA (blood, complications, drug therapy, physiopathology)
• Humans
• Male
• Proteinuria (etiology)
• Survival Analysis
• Treatment Outcome