title: Combined therapy of enalapril and losartan attenuates histologic progression in immunoglobulin A nephropathy.
abstract: BACKGROUND
  It has been reported that combined therapy of angiotensin converting enzyme inhibitor and angiotensin receptor blocker significantly decreases proteinuria in immunoglobulin A (IgA) nephropathy. However, histologic alterations following the therapy have not been reported.
  
  
  METHODS
  A total of nine Japanese children with severe proteinuric IgA nephropathy who received a prompt immunosuppressive therapy were enrolled the study, four of whom received a combined therapy of angiotensin converting enzyme inhibitor, enalapril and angiotensin receptor blocker, losartan (Group A), while the remaining five did not (Group B). All underwent renal biopsy before and approximately 12 months after the first renal biopsy.
  
  
  RESULTS
  At presentation, urine protein excretion and the histologic indices of mean activity index, mean chronicity index and tubulointerstitial scores did not show a statistical difference between the two groups: Group A (2.6 +/- 0.6 g/day; mean activity index, 5.0 +/- 1.0; mean chronicity index, 5.0 +/- 1.0; tubulointerstitial scores, 4.3 +/- 1.0) and Group B (2.2 +/- 0.6 g/day; mean activity index, 4.8 +/- 0.8; mean chronicity index, 4.8 +/- 1.3; tubulointerstitial scores, 3.6 +/- 0.5, respectively). All had normal blood pressure and renal function. Urine protein excretion and the activity index decreased at the second renal biopsy, while the chronicity index and the tubulointerstitial scores slightly increased or remained unchanged. In comparison with Group B, a significant suppression in increasing the chronicity index and the tubulointerstitial scores obtained at the second renal biopsy were observed in Group A [Group A: 4.3 +/- 1.2 and 3.0 +/- 0.0, respectively, vs Group B: 6.0 +/- 0.7 and 4.4 +/- 0.9, respectively (P < 0.05)]. One patient in Group B developed chronic renal insufficiency thereafter.
  
  
  CONCLUSIONS
  Although only a small number of patients were examined, these clinical findings suggest that a combined therapy of enalapril and losartan may attenuate histologic progression in at least a proportion of patients with severe proteinuric IgA nephropathy.
authors.affiliation: Department of Pediatrics, Hirosaki University School of Medicine, Hirosaki, Japan. hirotana@cc.hirosaki-u.ac.jp
authors.forename: Hiroshi
authors.initials: H
authors.lastname: Tanaka
authors.forename: Koichi
authors.initials: K
authors.lastname: Suzuki
authors.forename: Tohru
authors.initials: T
authors.lastname: Nakahata
authors.forename: Koji
authors.initials: K
authors.lastname: Tsugawa
authors.forename: Yuki
authors.initials: Y
authors.lastname: Konno
authors.forename: Kazushi
authors.initials: K
authors.lastname: Tsuruga
authors.forename: Etsuro
authors.initials: E
authors.lastname: Ito
authors.forename: Shinobu
authors.initials: S
authors.lastname: Waga
mesh_terms: D000293:Adolescent; D000959:Antihypertensive Agents / Q000627:therapeutic use; D001706:Biopsy; D002648:Child; D003404:Creatinine / Q000097:blood; D018450:Disease Progression; D004359:Drug Therapy, Combination; D004656:Enalapril / Q000627:therapeutic use*; D005260:Female; D005922:Glomerulonephritis, IGA / Q000150:complications / Q000188:drug therapy* / Q000473:pathology; D006801:Humans; D007564:Japan; D007668:Kidney / Q000187:drug effects / Q000473:pathology / Q000503:physiopathology; D019808:Losartan / Q000627:therapeutic use*; D008297:Male; D010865:Pilot Projects; D011507:Proteinuria / Q000188:drug therapy / Q000209:etiology; D016896:Treatment Outcome
chemical_list: D000959:Antihypertensive Agents; D004656:Enalapril; D003404:Creatinine; D019808:Losartan