Comparison of Higher Dose of Losartan Treatment with Losartan Plus Carvedilol and Losartan Plus Ramipril in Patients with Glomerulonephritis and Proteinuria

Abstract

Background. Proteinuria may cause a worsening of accompanying renal disease or even lead to glomerulosclerosis. There is no data about the effect of carvedilol on patients with proteinuric (>0.5 g/day) glomerulonephritis. This study aimed to compare the effects of carvedilol with ramipril and losartan in patients with proteinuric glomerulonephritis. Methods. Twenty-one glomerulonephritis patients were followed for 12 months. Patients were divided into three groups. All patients were treated with losartan 50 mg once daily for two weeks. After two weeks (baseline), patients were given additional medications: 50 mg losartan, 5 mg ramipril, and 25 mg carvedilol were given additionally to the patients in groups 1, 2, and 3 respectively. Results. Baseline mean proteinuria values of patients in groups 1, 2 and 3 were 1.6 ± 1.1 g/day, 2.1 ± 1.3 g/ day, and 1.4 ± 1.2 g/day, respectively. These values decreased to 0.5 ± 0.7 g/day, 0.6 ± 0.7 g/day, and 0.9 ± 0.9 g/day, respectively, at the end of the 12 th month. These results were statistically significant only in group 1 (p = 0.04). The rational variation of proteinuria between the first and 12 th month of losartan, ramipril, and carvedilol were −61%, −62%, and −27%, respectively. The decreases in blood pressures between baseline and the first, sixth, and twelfth-month measurements were significant in all groups. Conclusions. Thee results showed that angiotensin-converting enzyme inhibitors (ACEIs) and angiotensin receptor blockers (AT1ras) provide marked decreases in proteinuria, making their use indisputable in patients with glomerulonephritis. Carvedilol was not found to be as effective as ACEIs and AT1ras in decreasing proteinuria and preserving renal function.

Current treatment in acute and chronic cardio-renal syndrome

“…Studies with Carvedilol showed an attenuated increase in albuminuria, as well as a reduction in cardiovascular events in CKD patients with hypertension [30]. In spite of the finding of favorable effect or the lack of detrimental effect on renal function by the use of betablockers [31], the large randomized clinical HF trials on beta-blocker therapy excluded patients with severe renal dysfunction and did not consider their effects on renal outcome. In the ANZ trial, the creatinine cutoff adopted as exclusion criterion was [2.8 mg/dL, in the CIBIS-II was 3.4 mg/dL, whereas was not specified in the MERIT-HF and in the US Carvedilol Program [32].…”