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Long-term beneficial effects of angiotensin-converting enzyme inhibitor and angiotensin receptor blocker therapy for patients with advanced immunoglobulin A nephropathy and impaired renal function

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Abstract

Background

There are few reports analyzing the effects of angiotensin-converting enzyme inhibitors (ACEIs) and/or angiotensin receptor blockers (ARBs) on the long-term renal survival of advanced immunoglobulin A nephropathy (IgAN) patients.

Patients and methods

In this retrospective cohort analysis, we divided 66 IgAN patients with an estimated glomerular filtration rate (eGFR) <60 ml/min into three groups: ACEI group (n = 20, treated with ACEIs), ARB group (n = 23, treated with ARBs), and control group (n = 23, treated with antiplatelet agents), and analyzed the clinical and histological background, renal survival rate until the primary endpoint of 50% decrease of eGFR from baseline, and the secondary endpoint of progression to end-stage renal disease, and the risk factors for progression.

Results

The clinical and histological background without serum IgA and C3 were not significantly different among the three groups. The renal survival rate until the primary and secondary endpoints was significantly higher in the ACEI and ARB groups than in the control group. The independent risk factors for progression were higher mean blood pressure (hazard ratio [HR] 1.76, P = 0.04), higher histological grade (HR 2.54, P = 0.0184) at baseline, and without ACEIs or ARBs (HR 7.09, P = 0.001), but decreased proteinuria and blood pressure. The risk factors with resistance to ACEIs or ARBs were higher blood pressure and lower eGFR at baseline. There was no difference regarding the survival rate and the risk for progression between ACEI s and ARBs.

Conclusion

ACEIs or ARBs were effective for long-term renal survival of advanced IgAN, although proteinuria and blood pressure did not decrease.

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References

  1. Berger J, Hinglais N. Les dépôts intercapillaries d’IgA-IgG. J Urol Nephrol. 1968;74:694–5.

    CAS  Google Scholar 

  2. Barratt J, Feehally J. Treatment of IgA nephropathy. Kidney Int. 2006;69:1934–8.

    Article  CAS  PubMed  Google Scholar 

  3. Locatelli F, Del Vecchio L, Pozzi C. IgA glomerulonephritis: beyond angiotensin-converting enzyme inhibitors. Nat Clin Pract Nephrol. 2006;2:24–31.

    Article  CAS  PubMed  Google Scholar 

  4. Ballardie FW. Quantitative appraisal of treatment options for IgA nephropathy. J Am Soc Nephrol. 2007;18:2806–9.

    Article  CAS  PubMed  Google Scholar 

  5. Komatsu T, Fujimoto S, Hara S, Fukuda A, Fukudome K, Yamada K, et al. Recent therapeutic strategies improve renal outcome in patients with IgA nephropathy. Am J Nephrol. 2009;30:19–25.

    Article  CAS  PubMed  Google Scholar 

  6. Asaba K, Yojo A, Onozato ML, Kinugasa S, Miyazaki H, Miyashita K, et al. Long-term renal prognosis of IgA nephropathy with therapeutic trend shifts. Intern Med. 2009;48:83–90.

    Article  Google Scholar 

  7. Cheng J, Zhang W, Zhang XH, He Q, Tao XJ, Chen JH. ACEI/ARB therapy for IgA nephropathy: a meta analysis of randomised controlled trial. Int J Clin Pract. 2009;63:80–8.

    Article  Google Scholar 

  8. Dillon JJ. Angiotensin-converting enzyme inhibitors and angiotensin receptor blockers for IgA nephropathy. Semin Nephrol. 2004;24:218–24.

    Article  CAS  PubMed  Google Scholar 

  9. Joh K. Proposal for a new histological classification of IgA nephropathy in Japan and a preliminary report of the international clinic-pathological classification of IgA nephropathy. Jpn J Nephrol. 2008;50:448–55.

    Google Scholar 

  10. Praga M, Gutiérrez E, González E, Morales E, Hernández E. Treatment of IgA nephropathy with ACE inhibitors: a randomized and controlled trial. J Am Soc Nephrol. 2003;14:1578–83.

    Article  CAS  PubMed  Google Scholar 

  11. Kanno Y, Okada H, Yamaji Y, Nakazato Y, Suzuki H. Angiotensin-converting-enzyme inhibitors slow renal decline in IgA nephropathy, independent of tubulointerstitial fibrosis at presentation. QJM. 2005;98:199–203.

    Article  CAS  PubMed  Google Scholar 

  12. Nakamura T, Ushiyama C, Suzuki S, Hara M, Shimada N, Sekizuka K, et al. Effects of angiotensin-converting enzyme inhibitor, angiotensin II receptor antagonist and calcium antagonist on urinary podocytes in patients with IgA nephropathy. Am J Nephrol. 2000;20:373–9.

    Article  CAS  PubMed  Google Scholar 

  13. Li PKT, Leung CB, Chow KM, Cheng YL, Fung SKS, Mak SK, et al. Hong Kong study using valsartan in IgA nephropathy (HKVIN): a double-blind, randomized, placebo-controlled study. Am J Kidney Dis. 2006;47:751–60.

    Article  CAS  PubMed  Google Scholar 

  14. Woo KT, Chan CM, Tan HK, Choong HL, Foo M, Vathsala A, et al. Beneficial effects of high-dose losartan in IgA nephritis. Clin Nephrol. 2009;71:617–24.

    Article  CAS  PubMed  Google Scholar 

  15. Shimizu A, Takei T, Uchida K, Tsuchiya K, Nitta K. Low-dose losartan therapy reduces proteinuria in normotensive patients with immunoglobulin A nephropathy. Hypertens Res. 2008;31:1711–7.

    Article  CAS  PubMed  Google Scholar 

  16. Tomino Y, Kawamura T, Kimura K, Endoh M, Hosoya T, Horikoshi S, et al. Antiproteinuric effect of olmesartan in patients with IgA nephropathy. J Nephrol. 2009;22:224–31.

    CAS  PubMed  Google Scholar 

  17. Woo KT, Lau YK, Wong KS, Chiang GSC. ACEI/ATRA therapy decreases proteinuria by improving glomerular permselectivity in IgA nephritis. Kidney Int. 2000;58:2485–91.

    Article  CAS  PubMed  Google Scholar 

  18. Russo D, Minutolo R, Pisani A, Esposito R, Signoriello G, Andreucci M, et al. Coadministration of losartan and enalapril exerts additive antiproteinuric effect in IgA nephropathy. Am J Kidney Dis. 2001;38:18–25.

    Article  CAS  PubMed  Google Scholar 

  19. Horita Y, Tadokoro M, Taura K, Suyama N, Taguchi T, Miyazaki M, et al. Low-dose combination therapy with temocapril and losartan reduces proteinuria in normotensive patients with immunoglobulin A nephropathy. Hypertens Res. 2004;27:963–70.

    Article  CAS  PubMed  Google Scholar 

  20. Horita Y, Taura K, Taguchi T, Furusu A, Kohno S. Aldosterone breakthrough during therapy with angiotensin converting enzyme inhibitors and angiotensin II receptor blockers in proteinuric patients with immunoglobulin A nephropathy. Nephrology. 2006;11:462–6.

    Article  CAS  PubMed  Google Scholar 

  21. Miura N, Imai H, Kikuchi S, Hayashi S, Endoh Kawamura T, et al. Tonsillectomy and steroid pulse (TSP) therapy for patients with IgA nephropathy: a nationwide survey of TSP therapy in Japan and an analysis of the predictive factors for resistance to TSP therapy. Clin Exp Nephrol. 2009;13:460–6.

    Article  CAS  PubMed  Google Scholar 

  22. Hotta O, Miyazaki M, Furuta T, Tomioka S, Chiba S, Horigome I, et al. Tonsillectomy and steroid pulse therapy significantly impact on clinical remission in patients with IgA nephropathy. Am J Kidney Dis. 2001;38:736–43.

    Article  CAS  PubMed  Google Scholar 

  23. Hotta O. Use of corticosteroids, other immunosuppressive therapies, and tonsillectomy in the treatment of IgA nephropathy. Semin Nephrol. 2004;3:244–55.

    Article  Google Scholar 

  24. Appel GB, Waldman M. The IgA nephropathy treatment dilemma. Kidney Int. 2006;69:1939–44.

    Article  CAS  PubMed  Google Scholar 

  25. Cattran DC, Greenwood C, Ritchie S. Long-term benefits of angiotensin-converting enzyme inhibitor therapy in patients with severe immunoglobulin A nephropathy: a comparison to patients to receiving treatment with other antihypertensive agents and to patients receiving no therapy. Am J Kidney Dis. 1994;23:247–54.

    Article  CAS  PubMed  Google Scholar 

  26. Woo KT, Lau YK, Chan CM, Wong KS. Angiotensin-converting enzyme inhibitor versus angiotensin 2 receptor antagonist therapy and the influence of angiotensin-converting enzyme gene polymorphism in IgA nephritis. Ann Acad Med. 2008;37:372–6.

    Google Scholar 

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Acknowledgments

We thank Dr. Satoru Shimizu (Department of Medical Research Institute, Tokyo Women’s Medical University) for help with statistical analysis.

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Authors and Affiliations

  1. Department of Medicine, Kidney Center, Tokyo Women’s Medical University, 8-1 Kawada-cho, Shinjuku-ku, Tokyo, 162-8666, Japan

    Takahito Moriyama, Nobuyuki Amamiya, Ayami Ochi, Yuki Tsuruta, Ari Shimizu, Chiari Kojima, Mitsuyo Itabashi, Takashi Takei, Keiko Uchida & Kosaku Nitta

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  1. Takahito Moriyama
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  2. Nobuyuki Amamiya
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  3. Ayami Ochi
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  4. Yuki Tsuruta
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  5. Ari Shimizu
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  6. Chiari Kojima
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  7. Mitsuyo Itabashi
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  8. Takashi Takei
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  9. Keiko Uchida
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  10. Kosaku Nitta
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Correspondence to Takahito Moriyama.

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Moriyama, T., Amamiya, N., Ochi, A. et al. Long-term beneficial effects of angiotensin-converting enzyme inhibitor and angiotensin receptor blocker therapy for patients with advanced immunoglobulin A nephropathy and impaired renal function. Clin Exp Nephrol 15, 700–707 (2011). https://doi.org/10.1007/s10157-011-0455-8

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  • DOI: https://doi.org/10.1007/s10157-011-0455-8

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