title: High dose Losartan and ACE gene polymorphism in IgA nephritis.
abstract: Background/aims Several studies have reported varying results of the influence of ACE gene on ACEI/ARB therapy. The efficacy of high dose ARB and its influence on ACE gene have not been explored. This is a 6 year randomised trial in IgA nephritis comparing high dose ARB (Losartan 200 mg/day) with normal dose ARB (Losartan 100 mg/day), normal dose ACEI (20 mg/day) and low dose ACEI (10 mg/day). Results Patients on high dose ARB had significantly lower proteinuria, 1.0 +/- 0.8 gm/day compared to 1.7 +/- 1.0 g/day in the other groups (P = 0.0005). The loss in eGFR was 0.7 ml min(-1)year(-1) for high dose ARB compared to 3.2-3.5 ml min(-1)year(-1) for the other three groups (P = 0.0005). There were more patients on high dose ARB with improvement in eGFR compared to other three groups (P < 0.001). Comparing patients with the three ACE genotypes DD, ID and II, all three groups responded well to therapy with decrease in proteinuria (P < 0.002). Only those on low dose ACEI (10 mg/day) with the I allele had increased in ESRF (P = 0.037). Conclusion High dose ARB is more efficacious in reducing proteinuria and preserving renal function when compared with normal dose ARB and ACEI, and also obviates the genomic influence of ACE gene polymorphism on renal survival.
authors.affiliation: Department of Renal Medicine, Singapore General Hospital, Outram Road, Singapore, 169608, Singapore, woo.keng.thye@sgh.com.sg.
authors.forename: Keng-Thye
authors.initials: KT
authors.lastname: Woo
authors.forename: Choong-Meng
authors.initials: CM
authors.lastname: Chan
authors.forename: Hui-Lin
authors.initials: HL
authors.lastname: Choong
authors.forename: Han-Kim
authors.initials: HK
authors.lastname: Tan
authors.forename: Marjorie
authors.initials: M
authors.lastname: Foo
authors.forename: Evan J C
authors.initials: EJ
authors.lastname: Lee
authors.forename: Chorh-Chuan
authors.initials: CC
authors.lastname: Tan
authors.forename: Grace S L
authors.initials: GS
authors.lastname: Lee
authors.forename: Seng-Hoe
authors.initials: SH
authors.lastname: Tan
authors.forename: A
authors.initials: A
authors.lastname: Vathsala
authors.forename: Cheng-Hong
authors.initials: CH
authors.lastname: Lim
authors.forename: Gilbert S C
authors.initials: GS
authors.lastname: Chiang
authors.forename: Stephanie
authors.initials: S
authors.lastname: Fook-Chong
authors.forename: Zhao
authors.initials: Z
authors.lastname: Yi
authors.forename: H B
authors.initials: HB
authors.lastname: Tan
authors.forename: Kok-Seng
authors.initials: KS
authors.lastname: Wong