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Abstract

Primary membranoproliferative glomerulonephritis (MPGN) has a poor long-term prognosis, with 40 per cent of patients reaching end-stage renal failure after 10 years of observation. Approximately 35 per cent of patients die due to complications of the nephrotic syndrome. This study investigates the effect of acetylsalicylic acid (ASA) combined with dipyridamole on proteinuria and renal function in nephrotic MPGN patients with normal/moderately reduced glomerular filtration rate (GFR). Fourteen patients with biopsy-proven type I MPGN received ASA (1000 mg/day) and dipyridamole (300 mg/day) for 24 months. Proteinuria was reduced from 6.8 +/- 2.4 g/day to 1.1 +/- 0.6 g/day (p < 0.001). Serum albumin levels increased from 2.2 +/- 0.5 g/dL to 3.7 +/- 0.4 g/dL (p < 0.001) during the study period after 24 months compared to baseline. Serum creatinine and GFR did not significantly change in patients treated with acetylsaliclylic acid and dipyridamole during the observation period (p < 0.05). Our study suggests that ASA combined with dipyridamole significantly reduces proteinuria without impairing renal function in patients with MPGN.

Dipyridamole decreases dialysis risk and improves survival in patients with pre-dialysis advanced chronic kidney disease

“…In two meta-analyses of antiplatelet therapy for IgA nephropathy, dipyridamole therapy was beneficial for reducing the risk of proteinuria [ 27 , 28 ]. In addition, dipyridamole combination therapy with ACE-I, antiplatelet agents or immunosuppressants significantly reduced proteinuria in patients with IgA nephropathy and primary membranoproliferative glomerulonephritis [ 18 , 19 , 29 , 30 ]. However, our knowledge about the reno-protective effect of dipyridamole use is limited in pre-dialysis, advanced CKD patients.…”

“…Dipyridamole stimulates nitric oxide action and inhibits platelet aggregation via the inhibition of phosphodiesterase and has an antioxidant effect [ 14 – 16 ]. A number of clinical studies have shown the reno-protective effects of dipyridamole monotherapy or combination therapy with ACEIs, antiplatelet agents or immunosuppressants in the treatment of early CKD in patients with diabetic kidney disease, IgA nephropathy, and membranoproliferative glomerulonephritis [ 17 – 19 ]. However, studies focusing on dipyridamole monotherapy or its interaction with RAAS blockade in patients with CKD 5 ND that have used hard end points, such as ESRD and mortality, are limited.…”