Dual Therapy with ACE Inhibitors and Angiotensin II Receptor Blockers in Proteinuric IgA Nephropathy Patients
Article Outline
Experimental evidence supports dual pharmacologic blockade of the renin–angiotensin system with angiotensin-converting enzyme inhibitors and angiotensin II receptor blockers in proteinuric renal disease. Nonetheless, exaggerated therapeutic benefits are frequently the rule rather than the exception in the experimental or trial setting. The difference between the clinical trial setting (efficacy) and actual practice (effectiveness) should be borne in mind before the recommendation of any new therapy as the standard of care. With this in mind, we examined the effectiveness and safety of dual therapy on a cohort of adults with proteinuric IgA nephropathy in a usual clinical setting. The primary end point was reduction in proteinuria, which has been shown to be a significant risk factor for end-stage renal disease. [Hong Kong J Nephrol 2007;9(2):89–93]
Key words: angiotensin-converting enzyme (ACE) inhibitor , angiotensin II receptor blocker , IgA nephropathy , outcome , proteinuria
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References
- . Combination therapy with ACE inhibitors and angiotensin II receptor blockers to halt progression of chronic renal disease: pathophysiology and indications . Kidney Int . 2005;67:799–812
- . Combination therapy with an angiotensin receptor blocker and an angiotensin receptor blocker and an ACE inhibitor in proteinuric renal disease: a systemic review of the efficacy and safety data . Am J Kidney Dis . 2006;48:8–20
- . Management of glomerular proteinuria: a commentary . J Am Soc Nephrol . 2003;14:3217–3232
- Outcome of IgA nephropathy in adults graded by chronic histological lesions . Am J Kidney Dis . 2000;35:392–400
- Characterization of early IgA nephropathy . Am J Kidney Dis . 2000;36:703–708
- Primary IgA nephropathy with low histologic grade and disease progression: is there a “point of no return”? . Am J Kidney Dis . 2002;39:401–406
- . Dual blockade of the reninangiotensin system in the progression of renal disease: the need for more clinical trials . J Am Soc Nephrol . 2006;17:S250–S254
- Modified glomerular filtration rate estimating equation for Chinese patients with chronic kidney disease . J Am Soc Nephrol . 2006;17:2937–2944
- World Health Organization Collaborating Centre for Drug Statistics Methodology Anatomical Therapeutical Chemical (ATC) (1994) Classification Index Including Defined Daily Doses (DDDs) for Plain Substances. Oslo: WHO. Available at http://www.whocc.no/atcddd/ [Date accessed: March 25, 2007]
- . Reduction of proteinuria; combined effects of receptor blockade and low-dose angiotensin-converting enzyme inhibition . J Hypertens . 2002;20:739–743
- . Randomized controlled crossover study of the effect on proteinuria and blood pressure of adding an angiotensin II receptor antagonist to an angiotensin converting enzyme inhibitor in normotensive patients with chronic renal disease and proteinuria . Nephrol Dial Transplant . 2002;17:597–601
- . Low-dose dual blockade of the reninangiotensin system in patients with primary glomerulonephritis . Am J Kidney Dis . 2004;43:260–268
- . Salt intake and non-ACE pathways for intrarenal angiotensin II generation in man . J Renin Angiotensin Aldosterone Syst . 2001;2:14–18
- . ACEI/ATRA therapy decreases proteinuria by improving glomerular permselectivity in IgA nephritis . Kidney Int . 2000;58:2485–2491
- . The effects of dual blockade of the renin-angiotensin system on urinary protein and transforming growth factor-beta excretion in 2 groups of patients with IgA and diabetic nephropathy . Clin Nephrol . 2003;60:318–326
- Effect of losartan and amlodipine on proteinuria and transforming growth factor-β1 in patients with IgA nephropathy . Nephrol Dial Transplant . 2003;18:1115–1121
- Hong Kong study using valsartan in IgA nephropathy (HKVIN): a double-blind, randomized, placebo-controlled study . Am J Kidney Dis . 2006;47:751–760
- . Treatment with low-dose angiotensin-converting enzyme inhibitor (ACEI) plus angiotensin II receptor blocker (ARB) in pediatric patients with IgA nephropathy . Clin Nephrol . 2005;64:35–40
- . Aldosterone breakthrough during therapy with angiotensin-converting enzyme inhibitors and angiotensin II receptor blockers in proteinuric patients with immunoglobulin A nephropathy . Nephrology (Carlton) . 2006;11:426–466
- . Additive antiproteinuric effect of converting enzyme inhibitor and losartan in normotensive patients with IgA nephropathy . Am J Kidney Dis . 1999;33:851–856
- . Aldosterone antagonism in chronic kidney disease . Clin J Am Soc Nephrol . 2006;1:668–677
- . Combination treatment of angiotensin-converting-enzyme inhibitor in non-diabetic renal disease (COOPERATE): a randomised controlled trial . Lancet . 2003;361:117–124
- . Add-on angiotensin receptor blocker in patients who have proteinuric chronic kidney diseases and are treated with angiotensin-converting enzyme inhibitors . Clin J Am Soc Nephrol . 2006;1:730–737
- . IgA nephropathy inhibitors of the renin angiotensin system: is reduction in proteinuria adequate proof of efficacy? . Am J Kidney Dis . 2001;38:182–185
- . Progression of chronic kidney disease: the role of blood pressure control, proteinuria, and angiotensin-converting enzyme inhibition: a patient-level meta-analysis . Ann Intern Med . 2003;139:244–252
- . Angiotensin-converting enzyme inhibition and angiotensin II antagonism in nondiabetic chronic nephropathies . Semin Nephrol . 2004;24:158–167
PII: S1561-5413(08)60007-1
doi:10.1016/S1561-5413(08)60007-1
© 2007 The Hong Kong Society of Nephrology. Published by Elsevier Inc. All rights reserved.
