Dual renin-angiotensin system blockade plus oral methylprednisone for the treatment of proteinuria in IgA nephropathy

• Published in: Medicina (Buenos Aires) Vol. 67; no. 5; pp. 445 - 450
• Main Authors: Trimarchi, Hernán, Muryan, Alexis, Young, Pablo, Forrester, Mariano, Iotti, Alejandro, Pereyra, Horacio, Lombi, Fernando, Seminario, Omar, Alonso, Mirta, Iotti, Roberto
• Format: Journal Article
• Language: English
• Published: Argentina 2007
• Subjects: Administration, Oral; Adult; Angiotensin II Type 1 Receptor Blockers - administration & dosage; Angiotensin-Converting Enzyme Inhibitors - administration & dosage; Creatinine - blood; Drug Therapy, Combination; Female; Follow-Up Studies; Glomerulonephritis, IGA - drug therapy; Glomerulonephritis, IGA - pathology; Glomerulonephritis, IGA - urine; Glucocorticoids - administration & dosage; Humans; Hypertension - drug therapy; Male; Prednisolone - administration & dosage; Prednisolone - analogs & derivatives; Prospective Studies; Proteinuria - drug therapy; Renin-Angiotensin System - drug effects; Transforming Growth Factor beta - urine
• ISSN: 0025-7680

Renin-angiotensin system inhibition is a widely accepted approach to initially deal with proteinuria in IgA nephropathy, while the role of immunosuppressants remains controversial in many instances. A prospective, uncontrolled, open-label trial was undertaken in patients with biopsy-proven IgA nephropathy with proteinuria > 0.5 g/day and normal renal function to assess the efficacy of a combination treatment of angiotensin converting enzyme inhibitors plus angiotensin receptor blockers enalapril valsartan coupled with methylprednisone to decrease proteinuria to levels below 0.5 g/day. Twenty patients were included: Age 37.45 +/- 13.26 years (50% male); 7 patients (35%) were hypertensive; proteinuria 2.2 +/- 1.86 g/day; serum creatinine 1.07 +/- 0.29 mg/dl; mean follow-up 60.10 +/- 31.47 months. IgA nephropathy was subclassified according to Haas criteria. Twelve patients (60%) were class II; seven (35%) were class III and one (5%) class V. All patients received dual renin-angiotensin system blockade as tolerated. Oral methylprednisone was started at 0.5 mg/kg/day for the initial 8 weeks and subsequently tapered bi-weekly until the maintenance dose of 4 mg was reached. Oral steroids were discontinued after 24 weeks (6 months) of therapy but renin-angiotensin inhibition remained unchanged. At 10 weeks of therapy proteinuria decreased to 0.15 +/- 0.07 g/day (P < 0.001) while serum creatinine did not vary: 1.07 +/- 0.28 mg/dl (P = ns). After a mean follow-up of 42.36 +/- 21.56 months urinary protein excretion (0.12 +/- 0.06 g/day) and renal function (serum creatinine 1.06 +/- 0.27 mg/dl) remained stable. No major side effects were reported during the study. Renin-angiotensin blockade plus oral steroids proved useful to significantly decrease proteinuria to < 0.5 g/day in patients with IgA nephropathy without changes in renal function.