Renin-angiotensin system blockade in biopsy-proven allograft nephropathy.
Allograft nephropathy leads to progressive renal injury and ultimate graft loss. In native kidney disease, the use of angiotensin-converting enzyme inhibitors (ACEi) or angiotensin receptor blockers (ARB) is beneficial in retarding the decline of renal function. We reviewed a cohort of renal transplant recipients who were prescribed either an ACEi or ARB for biopsy-proven allograft nephropathy. Patients were followed from time of initiation of ACEi/ARB and were stratified based on biopsy findings. Outcomes of interest included safety, allograft survival, renal function, and rate of renal function decline pre- and post-ACEi/ARB. The 5-year allograft survival after biopsy was 83%. Mean serum creatinine was 2.2 +/- 1.1 mg/dL (range 1.0 to 4.3) at time of biopsy and 2.6 +/- 1.2 mg/dL (1.2 to 6.5) at last follow-up. The mean slope of the creatinine versus time (SD) was 2.43 (7.93) in the 12 months prior to therapy and 1.45 (3.66) following therapy, with the absolute difference in slope -3.38 (6.06) (P =.0004). We conclude that treatment with ACEi/ARB is beneficial in the management of allograft nephropathy.
Zaltzman
J S
JS
Renal Transplant Program, Division of Nephrology, St Michael's Hospital, Department of Medicine, University of Toronto, Toronto, Ontario, Canada. jeffrey.zaltzman@utoronto.ca
Nash
M
M
Chiu
R
R
Prasad
G V R
GV
D057911:Angiotensin Receptor Antagonists; D000806:Angiotensin-Converting Enzyme Inhibitors / Q000627:therapeutic use; D001706:Biopsy; D002908:Chronic Disease; D003404:Creatinine / Q000097:blood / Q000652:urine; D006801:Humans; D016030:Kidney Transplantation / Q000473:pathology*; D011183:Postoperative Complications / Q000145:classification / Q000473:pathology; D012084:Renin-Angiotensin System / Q000187:drug effects*; D012189:Retrospective Studies
D057911:Angiotensin Receptor Antagonists; D000806:Angiotensin-Converting Enzyme Inhibitors; D003404:Creatinine