Combined therapy of enalapril and losartan attenuates histologic progression in immunoglobulin A nephropathy.
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.
Tanaka
Hiroshi
H
Department of Pediatrics, Hirosaki University School of Medicine, Hirosaki, Japan. hirotana@cc.hirosaki-u.ac.jp
Suzuki
Koichi
K
Nakahata
Tohru
T
Tsugawa
Koji
K
Konno
Yuki
Y
Tsuruga
Kazushi
K
Ito
Etsuro
E
Waga
Shinobu
S
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
D000959:Antihypertensive Agents; D004656:Enalapril; D003404:Creatinine; D019808:Losartan