Recent immunosuppressive treatments for
lupus nephritis have improved renal survival rate, however, there still exists
lupus nephritis refractory to these treatments.
Angiotensin receptor blockers (ARBs) are known not only to decrease blood pressure but also to have an independent renoprotecting effect by interrupting renin-angiotensin system. The aim of this study was to evaluate whether ARBs have an additive effect on refractory
lupus nephritis. Enrolled in this trial were twelve patients with
lupus nephritis who were diagnosed by renal biopsy and remained
proteinuria despite
corticosteroids and/or immunosuppressive treatments. ARB,
losartan or
candesartan, was administered for six months. Various clinical parameters were compared before and after ARB administration.
Proteinuria decreased after ARB treatment in 83% of the patients and the median amount of
proteinuria significantly decreased from 2530 mg/g Cr to 459 mg/g Cr (P = 0.03). In addition,
serum albumin and
cholesterol levels were significantly improved. Systolic blood pressure significantly decreased, but none had symptoms of
hypotension. The antiproteinuric effect of ARB did not correlate with the reduction of blood pressure. Interestingly, higher total
complement activity levels before ARB treatment were associated with a greater reduction of
proteinuria. The addition of ARB would be a safe and effective treatment for
lupus nephritis with persistent
proteinuria despite
corticosteroids and/or immunosuppressive treatments.