Remission achieved in chronic nephropathy by a multidrug approach targeted at urinary protein excretion.
Regardless of the pattern of renal involvement, increased urinary protein excretion rate is the best independent predictor of progression of chronic nephropathies and short-term reduction in proteinuria has been reported to be renoprotective in the long term. Despite such evidence, however, the therapeutic target in renoprotection is almost exclusively on blood pressure control. We report the clinical course of a patient with chronic nephropathy after the institution of a multidrug treatment titrated against urinary protein excretion to achieve renoprotection. The present findings indicate that adjusting renoprotective therapy according to the decline in protein excretion in a multidrug strategy may stabilize or even reverse renal disease progression. This approach should be formally explored in prospective studies.
Ruggenenti
P
P
Mario Negri Institute for Pharmacological Research, Clinical Research Center for Rare Diseases Aldo e Cele Daccò, Villa Camozzi, Ranica, and Unit of Nephrology, Ospedali Riuniti, Azienda Ospedaliera, Bergamo, Italy.
Brenner
B M
BM
Remuzzi
G
G
D000328:Adult; D000465:Algorithms; D057911:Angiotensin Receptor Antagonists; D000806:Angiotensin-Converting Enzyme Inhibitors / Q000008:administration & dosage; D004232:Diuretics; D004359:Drug Therapy, Combination; D004656:Enalapril / Q000008:administration & dosage; D005260:Female; D006801:Humans; D006852:Hydrochlorothiazide / Q000008:administration & dosage; D007674:Kidney Diseases / Q000188:drug therapy* / Q000473:pathology; D007676:Kidney Failure, Chronic / Q000188:drug therapy; D019808:Losartan / Q000008:administration & dosage; D008181:Lupus Nephritis / Q000188:drug therapy / Q000473:pathology; D011507:Proteinuria / Q000188:drug therapy*; D049993:Sodium Chloride Symporter Inhibitors / Q000008:administration & dosage
D057911:Angiotensin Receptor Antagonists; D000806:Angiotensin-Converting Enzyme Inhibitors; D004232:Diuretics; D049993:Sodium Chloride Symporter Inhibitors; D006852:Hydrochlorothiazide; D004656:Enalapril; D019808:Losartan