OB-FSG indicates a poor prognosis with almost one-half of patients developing advanced renal failure. Knowledge of the clinico-pathological features of this entity (obesity, FSG lesions with glomerulomegaly, absence of nephrotic syndrome despite nephrotic-range proteinuria) should be helpful in establishing an accurate and early diagnosis.
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 Ն 0.5 g/d, and serum creatinine (SCr) Յ 1.5 mg/dl were randomly assigned either to receive enalapril (n ϭ 23) or to a control group (n ϭ 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 Ͼ 1.5 mg/dl at the last visit and the evolution of proteinuria. Baseline clinical findings were similar at baseline between enalapriltreated and control group, and there were no differences in BP control during follow-up. Mean follow-up was 78 Ϯ 37 mo in the enalapril group and 74 Ϯ 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 Ͻ 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 Ͻ 0.05). Three patients in the enalapril group (13%) and 11 (52%) in the control group showed SCr Ͼ 1.5 mg/dl at the last visit (P Ͻ 0.05). Proteinuria significantly decreased in the enalapril group, whereas it tended to increase in the control group (P Ͻ 0.001 between groups). In conclusion, ACE inhibitors significantly improve renal survival in proteinuric IgAN with normal or moderately reduced renal function.A considerable proportion (40 to 60% according to different series) of IgA nephropathy (IgAN) patients develop progressive renal insufficiency (1-4). Impairment in renal function, high BP, and proteinuria Ͼ 1 g/d are considered as the more important clinical predictors of an unfavorable evolution (1-6). With the exception of those patients who develop glomerular crescents or malignant hypertension, the rate of progression in IgAN patients with an unfavorable evolution is remarkably slow; end-stage renal failure develops in 20% of the cases after 10 yr and in 30% after 20 yr (1).Notwithstanding to be the most common type of glomerular disease in the world, surprisingly few prospective and controlled studies focused on the therapy of IgAN have been performed. Corticosteroids have shown a beneficial effect on the progression of IgAN in some randomized clinical trials (7,8), but concerns about its possible side effects in a disease with such a lengthy clinical course have been raised. Fish oil induced a decline in the rate of progression in a controlled study (9), but other studies failed to confirm this beneficial influence (10).Several multicenter and prospective studies have demonstrated that ACE inhibitors induce a significant renoprotective effect on the progression rate of both diabetic and nondiabetic chronic proteinuric nephropathies (11,12,13). This beneficial influence is closely related...
Obese patients are at risk for developing proteinuria and chronic renal failure after unilateral nephrectomy. Regular and long-term follow-up are recommended in these patients.
scite is a Brooklyn-based organization that helps researchers better discover and understand research articles through Smart Citations–citations that display the context of the citation and describe whether the article provides supporting or contrasting evidence. scite is used by students and researchers from around the world and is funded in part by the National Science Foundation and the National Institute on Drug Abuse of the National Institutes of Health.