title: Beneficial effects of high-dose losartan in IgA nephritis.
abstract: OBJECTIVE
  Several short-term studies have reported the efficacy of high-dose ARB in reducing proteinuria in patients with diabetic nephropathy. The benefits of long-term high-dose ARB losartan in IgA nephritis have not been explored.
  
  
  METHODS
  This was a 6-year randomized trial in 207 patients with 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). Multivariate ANOVA was used to test the effect of drug treatment on both eGFR and total urinary protein (TUP).
  
  
  RESULTS
  Comparing patients on high-dose ARB (n = 63) with those on normal dose ARB (n = 43), normal dose ACEI (n = 61) and low-dose ACEI (n = 40), patients on high Dose ARB had significantly higher eGFR (p < 0.0005) and lower proteinuria (p < 0.005) at the end of the study. The loss in eGFR was 0.7 ml/min/year for high-dose ARB compared to 3.2 - 3.5 ml/ min/year for the other 3 groups (p = 0.0005). There were more patients on high-dose ARB with improvement in eGFR compared to other 3 groups (p < 0.001).
  
  
  CONCLUSIONS
  Data from this study suggest that high-dose ARB therapy is more efficacious in reducing proteinuria and preserving renal function when compared with normal dose ARB and ACEI. In Year 5, patients on high-dose ARB had a gain in eGFR suggesting that there is possibility of recovery of renal function in these patients on long-term high-dose therapy.
authors.affiliation: Department of Renal Medicine, Singapore General Hospital, Singapore. woo.keng.thye@sgh.com.sg
authors.forename: K-T
authors.initials: KT
authors.lastname: Woo
authors.forename: C-M
authors.initials: CM
authors.lastname: Chan
authors.forename: H-K
authors.initials: HK
authors.lastname: Tan
authors.forename: H-L
authors.initials: HL
authors.lastname: Choong
authors.forename: M
authors.initials: M
authors.lastname: Foo
authors.forename: A
authors.initials: A
authors.lastname: Vathsala
authors.forename: E J C
authors.initials: EJ
authors.lastname: Lee
authors.forename: C-C
authors.initials: CC
authors.lastname: Tan
authors.forename: G S L
authors.initials: GS
authors.lastname: Lee
authors.forename: S H
authors.initials: SH
authors.lastname: Tan
authors.forename: C-H
authors.initials: CH
authors.lastname: Lim
authors.forename: G S C
authors.initials: GS
authors.lastname: Chiang
authors.forename: S
authors.initials: S
authors.lastname: Fook-Chong
authors.forename: S K S
authors.initials: SK
authors.lastname: Wong
mesh_terms: D000328:Adult; D047228:Angiotensin II Type 1 Receptor Blockers / Q000008:administration & dosage*; D000806:Angiotensin-Converting Enzyme Inhibitors / Q000008:administration & dosage*; D004305:Dose-Response Relationship, Drug; D004656:Enalapril / Q000008:administration & dosage*; D005260:Female; D005919:Glomerular Filtration Rate / Q000187:drug effects; D005922:Glomerulonephritis, IGA / Q000188:drug therapy*; D006801:Humans; D019808:Losartan / Q000008:administration & dosage*; D008297:Male; D016896:Treatment Outcome
chemical_list: D047228:Angiotensin II Type 1 Receptor Blockers; D000806:Angiotensin-Converting Enzyme Inhibitors; D004656:Enalapril; D019808:Losartan