Antiproteinuric Effect of Aliskiren versus Losartan in Primary Glomerulonephritis

Introduction: Treatment with renin-angiotensin-aldosterone-system (RAAS) blockers plays a major role in halting chonic kidney disease (CKD) progression. Aliskiren is the first orally available direct renin inhibitor (DRI). Objective: We studied the efficacy of aliskiren compared to losartan in patients with primary GN. Design and Method: This was a prospective open-label randomized control trial in patients with primary GN. Patients were randomized to receive either aliskiren or losartan to maximum tolerated doses for 24 weeks. Blood and urine investigations were measured at baseline and at 4-weekly intervals. Adverse effects were recorded. Results: 22 patients were recruited (aliskiren-11 and losartan-11). Their baseline characteristics were comparable with the exception of a higher proteinuria (uPCI) in the aliskiren arm. There were no significant differences in proteinuria, blood pressure and other renal parameters between both groups. At end-study, only patients in the aliskiren arm showed significant reductions in both the systolic blood pressure and in proteinuria. There were no changes in the other parameters of renal function over time and no adverse events occurred. Conclusion: Aliskiren appears to be as efficacious and tolerable as losartan both as an antihypertensive and antiproteinuric agent in this study.