title: Effect of low-dose valsartan on proteinuria in normotensive immunoglobulin A nephropathy with minimal proteinuria: a randomized trial.
abstract: OBJECTIVE
  Immunoglobulin A nephropathy (IgAN) is a generally progressive disease, even in patients with favorable prognostic features. In this study, we aimed to investigate the antiproteinuric effect and tolerability of low-dose valsartan (an angiotensin II receptor blocker) therapy in normotensive IgAN patients with minimal proteinuria of less than 0.5 to 1.0 g/day.
  
  
  METHODS
  Normotensive IgAN patients, who had persistent proteinuria with a spot urine protein-to-creatinine ratio of 0.3 to 1.0 mg/mg creatinine, were recruited from five hospitals and randomly assigned to either 40 mg of valsartan as the low-dose group or 80 mg of valsartan as the regular-dose group. Clinical and laboratory data were collected at baseline, and at 4, 8, 12, and 24 weeks after valsartan therapy.
  
  
  RESULTS
  Forty-three patients (low-dose group, n = 23; regular-dose group, n = 20) were enrolled in the study. Proteinuria decreased significantly not only in the regular-dose group but also in the low-dose group. The change in urine protein-to-creatinine ratio at week 24 was -41.3% ± 26.1% (p < 0.001) in the regular-dose group and -21.1% ± 45.1% (p = 0.005) in the low-dose group. In the low-dose group, blood pressure was constant throughout the study period, and there was no symptomatic hypotension. In the regular-dose group, blood pressure decreased at weeks 8 and 12. No significant change in glomerular filtration rate, serum creatinine level, or serum potassium level was observed during the study period.
  
  
  CONCLUSIONS
  Our results suggest that low-dose valsartan can significantly reduce proteinuria without causing any intolerability in normotensive IgAN patients with minimal proteinuria.
authors.affiliation: Division of Nephrology, Department of Internal Medicine, Konkuk University Medical Center, Seoul, Korea ; BK-21, Konkuk University School of Medicine, Seoul, Korea.
authors.forename: Young-Il
authors.initials: YI
authors.lastname: Jo
authors.affiliation: Division of Nephrology, Department of Internal Medicine, Konkuk University Medical Center, Seoul, Korea.
authors.forename: Ha-Young
authors.initials: HY
authors.lastname: Na
authors.affiliation: Division of Nephrology, Department of Internal Medicine, Kyung Hee University Hospital at Gangdong, Seoul, Korea.
authors.forename: Ju-Young
authors.initials: JY
authors.lastname: Moon
authors.affiliation: Division of Nephrology, Department of Internal Medicine, Hanyang University Guri Hospital, Guri, Korea.
authors.forename: Sang-Woong
authors.initials: SW
authors.lastname: Han
authors.affiliation: Division of Nephrology, Department of Internal Medicine, CHA Bundang Medical Center, CHA University, Seongnam, Korea.
authors.forename: Dong-Ho
authors.initials: DH
authors.lastname: Yang
authors.affiliation: Division of Nephrology, Department of Internal Medicine, Kyung Hee University Hospital at Gangdong, Seoul, Korea.
authors.forename: Sang-Ho
authors.initials: SH
authors.lastname: Lee
authors.affiliation: Division of Nephrology, Department of Internal Medicine, Gangnam Severance Hospital, Yonsei University College of Medicine, Seoul, Korea.
authors.forename: Hyeong-Cheon
authors.initials: HC
authors.lastname: Park
authors.affiliation: Division of Nephrology, Department of Internal Medicine, Gangnam Severance Hospital, Yonsei University College of Medicine, Seoul, Korea.
authors.forename: Hoon-Young
authors.initials: HY
authors.lastname: Choi
authors.affiliation: Department of Pathology, Konkuk University Medical Center, Seoul, Korea.
authors.forename: So-Dug
authors.initials: SD
authors.lastname: Lim
authors.affiliation: Department of Pathology, National Health Insurance Corporation Ilsan Hospital, Goyang, Korea.
authors.forename: Jeong-Hae
authors.initials: JH
authors.lastname: Kie
authors.affiliation: Division of Nephrology, Department of Internal Medicine, National Health Insurance Corporation Ilsan Hospital, Goyang, Korea.
authors.forename: Yong-Kyu
authors.initials: YK
authors.lastname: Lee
authors.affiliation: Division of Nephrology, Department of Internal Medicine, National Health Insurance Corporation Ilsan Hospital, Goyang, Korea.
authors.forename: Sug-Kyun
authors.initials: SK
authors.lastname: Shin
mesh_terms: D000328:Adult; D047228:Angiotensin II Type 1 Receptor Blockers / Q000008:administration & dosage* / Q000009:adverse effects; D015415:Biomarkers / Q000652:urine; D001794:Blood Pressure; D003404:Creatinine / Q000652:urine; D005260:Female; D005922:Glomerulonephritis, IGA / Q000175:diagnosis / Q000188:drug therapy* / Q000503:physiopathology / Q000652:urine; D006801:Humans; D008297:Male; D008875:Middle Aged; D011446:Prospective Studies; D011507:Proteinuria / Q000175:diagnosis / Q000188:drug therapy* / Q000503:physiopathology / Q000652:urine; D056910:Republic of Korea; D013997:Time Factors; D016896:Treatment Outcome; D000068756:Valsartan / Q000008:administration & dosage* / Q000009:adverse effects
chemical_list: D047228:Angiotensin II Type 1 Receptor Blockers; D015415:Biomarkers; D000068756:Valsartan; D003404:Creatinine
keywords: Angiotensin receptor antagonists; Glomerulonephritis, IGA; Proteinuria; Safety; Treatment outcome