Renal allograft protection with angiotensin II type 1 receptor antagonists.
The renal benefits of agents inhibiting the renin-angiotensin-aldosterone system in renal transplant recipients, i.e. preventing the development of chronic graft nephropathy, are supposed but not finally proven. In a double-blind, placebo-controlled, cross-over study, we evaluated the influence of losartan on surrogate markers of tubular injury, urine excretion of transforming growth factor beta-1 (TGF-beta1) and amino-terminal propeptide of type III procollagen (PIIINP) in 16 patients after transplantation. The patients received randomly either losartan (50-100 mg daily) or the beta-blocker carvedilol (12.5-25 mg) for 8 weeks, allowing a placebo washout between treatments. The target office through blood pressure (BP) was below 130/85 mmHg. The BP did not differ in the treatment periods. Losartan significantly decreased N-acetyl-beta-d-glucosaminidase and alfa-1 microglobulin excretion relative to placebo and carvedilol. Urine excretion of TGF-beta1 and PIIINP was significantly lower after losartan. In conclusion, losartan reduces urine excretion of proteins associated with tubular damage and graft fibrosis.
Tylicki
L
L
Department of Nephrology, Transplantology and Internal Medicine, Medical University of Gdansk, Poland.
Biedunkiewicz
B
B
Chamienia
A
A
Wojnarowski
K
K
Zdrojewski
Z
Z
Aleksandrowicz
E
E
Lysiak-Szydlowska
W
W
Rutkowski
B
B
D000328:Adult; D047228:Angiotensin II Type 1 Receptor Blockers / Q000008:administration & dosage* / Q000494:pharmacology; D015415:Biomarkers / Q000032:analysis; D002227:Carbazoles / Q000008:administration & dosage / Q000494:pharmacology; D000077261:Carvedilol; D018592:Cross-Over Studies; D004311:Double-Blind Method; D005260:Female; D005355:Fibrosis / Q000473:pathology / Q000517:prevention & control; D006801:Humans; D007668:Kidney / Q000187:drug effects / Q000473:pathology; D016030:Kidney Transplantation / Q000379:methods*; D007684:Kidney Tubules / Q000187:drug effects / Q000473:pathology; D019808:Losartan / Q000008:administration & dosage / Q000494:pharmacology; D008297:Male; D008875:Middle Aged; D011412:Propanolamines / Q000008:administration & dosage / Q000494:pharmacology; D020011:Protective Agents / Q000008:administration & dosage / Q000494:pharmacology; D011507:Proteinuria / Q000517:prevention & control
D047228:Angiotensin II Type 1 Receptor Blockers; D015415:Biomarkers; D002227:Carbazoles; D011412:Propanolamines; D020011:Protective Agents; D000077261:Carvedilol; D019808:Losartan