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

Abstract

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

Comparison of inhibitors of renin–angiotensin–aldosterone system (RAS) and combination therapy of steroids plus RAS inhibitors for patients with advanced immunoglobulin A nephropathy and impaired renal function

“…Therefore, these cases should be treated by combination therapy with steroids and RASIs. We have reported the beneficial effect of steroids and RASIs in advanced IgAN patients with impaired renal function [12,13], and that the effect of ARBs is equivalent to steroid therapy in preventing end-stage renal disease (ESRD) [14]. These results allow us to hypothesize that combination therapy with steroids and RASIs might be superior to monotherapy with RASIs.…”

“…Patients with systemic diseases such as diabetes mellitus, collagen diseases, abnormal hypergammaglobulinemia and chronic liver diseases were excluded from the study. We selected all patients who met the following criteria: (1) clinical grade 3 at the time of renal biopsy as determined according to the clinical grading criteria of the Japanese Society of Nephrology at the time of renal biopsy [grade 1, urinary protein excretion (U-Prot) \0.5 g/day; grade 2, estimated glomerular filtration rate (eGFR) C60 ml/min/1.73 m 2 and U-Prot C 0.5 g/day; grade 3, eGFR \ 60 ml/min/1.73 m 2 and U-Prot C 0.5 g/day] [13][14][15]; (2) U-Prot was under the nephrotic range (3.5 g/day) at the time of renal biopsy; and (3) patients were treated by monotherapy with RASIs or combination therapy with steroids and RASIs after renal biopsy. There were 63 patients who met these criteria.…”

“…Glomerular lesions were classified as global sclerosis, segmental sclerosis, and crescent formation. The grades were appended with 'A' when there were active lesions (e.g., cellular and fibrocellular crescents) and with 'C' when there were chronic lesions (e.g., global sclerosis, segmental sclerosis and fibrous crescents) [13][14][15]. These histological parameters were compared between the RASI and COMBI groups.…”

Advanced IgA nephropathy with impaired renal function benefits from losartan treatment in rats

“…20 However, the beneficial effects of ACEI/ARB on advanced IgAN were independent of the reduction of proteinuria and blood pressure. 19 The histological findings of the renal biopsy specimens showed approximately 65% of all IgAN patients weeks, TGF-b1, FN, a-SMA and FGF-1 expressions in the model group were significantly up-regulated as compared with the control group (p50.05). After losartan intervention, the expressions of the above factors were significantly down-regulated (p50.05) versus control group, (*p50.05) versus model group (p50.05).…”

“…18 Moreover, ACEIs or ARBs had beneficial effect equal to that with steroids for long-term renal survival of advanced IgAN, although proteinuria and blood pressure did not decrease. 19,20 According to the above results, we hypothesized that that ACEI/ARB treatment would play a beneficial role in renal pathological changes of advanced IgAN. Therefore, the present study was conducted to investigate the effect of losartan on advanced IgAN induced by staphylococcal enterotoxin B (SEB) 21 combined with 5/6 nephrectomy in rats.…”