title: The benefits of renin-angiotensin blockade in renal transplant recipients with biopsy-proven allograft nephropathy.
abstract: BACKGROUND
  Allograft nephropathy, regardless of aetiology, leads to progressive renal injury and eventual graft loss. In native kidney disease, treatment of hypertension, in particular with angiotensin-converting enzyme inhibitors (ACEi) or angiotensin receptor blockers (ARB), has proven beneficial in retarding renal function decline. In the present study, we reviewed the clinical course of a renal transplant recipient cohort that was prescribed either an ACEi or ARB for biopsy-proven allograft nephropathy.
  
  
  METHODS
  Patients were followed from the time of post-biopsy initiation of ACEi/ARB and were stratified based on biopsy findings. Outcomes of interest included safety, allograft survival, renal function and change in slope of renal function pre- and post-ACEi/ARB.
  
  
  RESULTS
  The 5 year allograft survival after biopsy diagnosis of allograft nephropathy was 83%. Serum creatinine was 191+/-97 (86-377) micromol/l at the time of biopsy and 228+/-102 (102-575) micromol/l at last follow-up. The slopes of reciprocal creatinine vs time were used to calculate the decline in renal function and were compared pre- and post-ACEi/ARB. The mean slope+/-SD was -0.06+/-0.21 l/micromol x 10(-3) per month in the 12 months prior to therapy and -0.03+/-0.09 l/micromol x 10(-3) per month following therapy. The absolute difference in slopes was 0.03 (P =<0.0001).
  
  
  CONCLUSIONS
  Treatment with ACEi/ARB may be beneficial in the management of allograft nephropathy.
authors.affiliation: Director of Renal Transplantation, Division of Nephrology, Dept of Medicine, University of Toronto, St Michael's Hospital, 30 Bond St, Toronto, Ontario, Canada M5B 1W8. jeffrey.zaltzman@utoronto.ca
authors.forename: Jeffrey S
authors.initials: JS
authors.lastname: Zaltzman
authors.forename: Michelle
authors.initials: M
authors.lastname: Nash
authors.forename: Rick
authors.initials: R
authors.lastname: Chiu
authors.forename: Ramesh
authors.initials: R
authors.lastname: Prasad
mesh_terms: D000328:Adult; D000368:Aged; D057911:Angiotensin Receptor Antagonists; D000806:Angiotensin-Converting Enzyme Inhibitors / Q000627:therapeutic use*; D001706:Biopsy; D005260:Female; D006801:Humans; D007674:Kidney Diseases / Q000188:drug therapy* / Q000473:pathology*; D016030:Kidney Transplantation / Q000473:pathology*; D008297:Male; D008875:Middle Aged; D011183:Postoperative Complications / Q000188:drug therapy* / Q000473:pathology*; D013997:Time Factors
chemical_list: D057911:Angiotensin Receptor Antagonists; D000806:Angiotensin-Converting Enzyme Inhibitors