Urinary Angiotensinogen Could Be a Prognostic Marker of the Renoprotection of Olmesartan in Metabolic Syndrome Patients

Abstract

This study was performed to demonstrate urinary angiotensinogen as a potential prognostic marker of the albuminuria reduction effects of olmesartan in patients with metabolic syndrome. In 24 patients (eight women, 57.88 ± 2.00 years), 5–40 mg/day of olmesartan were given. Urinary concentrations of albumin and angiotensinogen (normalized by urinary concentrations of creatinine) and plasma renin activity were measured before and after the 12- and 24-week marks of olmesartan treatment. Olmesartan treatment increased plasma renin activity and decreased urinary albumin and urinary angiotensinogen significantly (p < 0.05). Based on the % change in urinary albumin, patients were divided into two groups, responders (<−50%) and non-responders (≥−50%), and a logistic analysis of urinary angiotensinogen before treatment showed the area under the curve as 0.694. When the cutoff value of urinary angiotensinogen before the treatment of 13.9 µg/g Cr was used, the maximum Youden index (0.500, specificity: 11/12 = 91.7% and sensitivity: 7/12 = 58.3%) was obtained. When all patients were re-divided into two groups, those with higher values of urinary angiotensinogen before the treatment (Group H, n = 16) and those with lower values, Group H showed significantly decreased urinary albumin (p < 0.05). Therefore, urinary angiotensinogen could be a prognostic marker of the albuminuria reduction effects of olmesartan in patients with metabolic syndrome.

Effects of Olmesartan and Azilsartan on Albuminuria and the Intrarenal Renin-Angiotensin System

“…Regarding the renal protective effects, urinary albumin and u-AGT both tended to decrease in the olmesartan group, as observed in the study by Mizushige et al [17]. These authors reported that urinary albumin and u-AGT simultaneously decreased after olmesartan was administered to patients with metabolic syndrome [17]. The present study, which included few hypertensive patients with metabolic syndrome (olmesartan group: body mass index, 24), showed a similar tendency.…”

“…The antihypertensive effect observed in this subanalysis was comparable to that observed in the CANZONE study [1] and the MUSCAT-4 study [2]. Regarding the renal protective effects, urinary albumin and u-AGT both tended to decrease in the olmesartan group, as observed in the study by Mizushige et al [17]. These authors reported that urinary albumin and u-AGT simultaneously decreased after olmesartan was administered to patients with metabolic syndrome [17].…”

“…Recently, it was reported that olmesartan reduces urinary albumin and u-AGT [17]. We hypothesized that decreased u-AGT contributes to the renal protective actions of ARBs through the inhibition of intrarenal RAS.…”

Effect of a SGLT2 inhibitor on the systemic and intrarenal renin–angiotensin system in subtotally nephrectomized rats

“… 7 These data indicate that the diuretic effect of a SGLT2 inhibitor is soon compensated for, possibly by an adaptive physiological mechanism. In this regard, Cherny et al 8 reported that urinary angiotensinogen (AGT) excretion, which reflects intrarenal renin–angiotensin system (RAS) activity, 9 , 10 was significantly increased by treatment with a SGLT2 inhibitor in patients with type 1 diabetes mellitus. These data suggest that intrarenal RAS is activated to compensate for acute loss of sodium and body fluid.…”