title: Spironolactone Plus Full-Dose ACE Inhibition in Patients with Idiopathic Membranous Nephropathy and Nephrotic Syndrome: Does It Really Work?
abstract: We have studied the effects of add-on spironolactone treatment (100 mg/day) in 11 patients with idiopathic membranous nephropathy (IMN) and > 3 gm proteinuria/day despite angiotensin converting enzyme (ACE) inhibitor therapy titrated to a systolic/diastolic blood pressure < 120/80 mmHg. Blood pressure, 24-hour urinary protein excretion, and creatinine clearance were measured prior to, after two months of combined therapy, and after a 2-month withdrawal period of spironolactone. While systolic and diastolic blood pressure decreased significantly after spironolactone therapy, proteinuria did not improve. Serum potassium increased significantly as well, with three patients requiring resin-binding therapy. Thus, spironolactone seems to have no additional antiproteinuric effects over ACE inhibitor therapy in patients with IMN and nephrotic syndrome and carries the risk of significant hyperkalemia.
authors.affiliation: Clinical Research Center for Rare Diseases "Aldo e Cele Daccò", Villa Camozzi, Ranica, Italy.|Department of Medicine and Transplantation, Ospedali Riuniti-Mario Negri Institute for Pharmacological Research, Bergamo, Italy.
authors.forename: Paolo
authors.initials: P
authors.lastname: Cravedi
authors.affiliation: Clinical Research Center for Rare Diseases "Aldo e Cele Daccò", Villa Camozzi, Ranica, Italy.|Department of Medicine and Transplantation, Ospedali Riuniti-Mario Negri Institute for Pharmacological Research, Bergamo, Italy.
authors.forename: Varusca
authors.initials: V
authors.lastname: Brusegan
authors.affiliation: Clinical Research Center for Rare Diseases "Aldo e Cele Daccò", Villa Camozzi, Ranica, Italy.|Department of Medicine and Transplantation, Ospedali Riuniti-Mario Negri Institute for Pharmacological Research, Bergamo, Italy.
authors.forename: Piero
authors.initials: P
authors.lastname: Ruggenenti
authors.affiliation: Division of Nephrology, Department of Medicine, University of Alabama, Birmingham, Birmingham, AL 35294, USA.
authors.forename: Ruth
authors.initials: R
authors.lastname: Campbell
authors.affiliation: Clinical Research Center for Rare Diseases "Aldo e Cele Daccò", Villa Camozzi, Ranica, Italy. giuseppe.remuzzi@marionegri.it.|Department of Medicine and Transplantation, Ospedali Riuniti-Mario Negri Institute for Pharmacological Research, Bergamo, Italy. giuseppe.remuzzi@marionegri.it.
authors.forename: Giuseppe
authors.initials: G
authors.lastname: Remuzzi
keywords: hyperkalemia; idiopathic membranous nephropathy; proteinuria; spironolactone