Kawamura T, Yoshida H, Hamaguchi A, Utsunomiya Y, Miyazaki Y,
Mitarai T, Ichikawa I, Sakai O
Sodium-dependency of urinary protein excretion is a functional
parameter for intrarenal angiotensin and predictor of renoprotective
effect of ACE inhibition in IgA nephropathy patients
Am Soc Nephrol
J Am Soc Nephrol (abstract)
(Sep) 7:1321 1996
Sodium-dependency of proteinuria may indicate the status of the
intrarenal renin-angiotensin system and predict antiproteinuric
response to ACE inhibition. This study was designed to determine
if patients with IgA nephropathy in whom sodium restriction or ACE
inhibitors had greater antiproteinuric effects had better long-term
renal outcome on ACE inhibitors.
45 patients with IgA nephropathy
treated with ACE inhibitors were divided into two groups based on
whether urinary sodium excretion did or did not correlate with
response of proteinuria to ACE inhibition: urinary sodium-dependent
proteinuria (SD) (n=24) or urinary sodium-independent
proteinuria (SI) (n=21). Mean follow-up periods in the SD and SI
groups were 4.0 and 3.6 yrs, respectively.
The slope of Ccr vs.
time was significantly less negative in the SD than the SI group
(+1.97 vs. -2.15 ml/min/yr, p < 0.005). In addition, the DD
phenotype was significantly more frequent in the SD (40%) than the
SI (7.7%) group. The authors conclude that there are two groups of
patients with IgA nephropathy, i.e. one with and the other without
significant intrarenal angiotensin action. Patients who have SD,
have an antiproteinuric response to ACE inhibitors, tend to have the DD
phenotype, and appear to have preferential long-term renal protection
from ACE inhibitors.
Comment: This study supports the concept that long-term
beneficial
effects of ACE inhibitors can be predicted based on clinical
parameters that reflect heightened intrarenal angiotensin action.
(David J. Leehey, M.D., Loyola University at Chicago)
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Am Soc Nephrol
Proteinuria/Hematuria :
IgA Nephropathy