What question did this study set out to answer?

To assess whether adding an angiotensin receptor blocker to an angiotensin-converting enzyme inhibitor further reduces urinary protein excretion and to investigate the underlying mechanisms.

July 1, 2003Clinical Nephrology

Combined converting enzyme inhibition and angiotensin receptor blockade reduce proteinuria greater than converting enzyme inhibition alone: insights into mechanism

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Why the study?

Does adding losartan to CEI reduce urinary protein excretion in patients with renal disease and persistent proteinuria?

Key Points

To assess whether adding an angiotensin receptor blocker to an angiotensin-converting enzyme inhibitor further reduces urinary protein excretion and to investigate the underlying mechanisms.
Enrolled patients with diverse renal diseases and persistent proteinuria (517 to 8,562 mg/24 h) despite at least 4 weeks of baseline angiotensin-converting enzyme inhibitor (CEI) therapy.
Administered add-on losartan at 50 mg/day following baseline measurements, reassessing urinary protein excretion, blood pressure, plasma renin activity, and plasma aldosterone after 1 month.
Adding losartan reduced urinary protein excretion by 45 ± 8% compared with CEI alone (p < 0.005), an effect observed across all patients regardless of baseline proteinuria, renal diagnosis, or changes in mean arterial pressure.
Plasma renin activity increased in 7 of 10 subjects after ARB addition (p < 0.03), while plasma aldosterone acutely decreased in 9 of 10 subjects (p < 0.009).

Structured PICO

Does adding losartan to CEI reduce urinary protein excretion in patients with renal disease and persistent proteinuria?

Population

10 patients with various renal diseases and significant proteinuria (range 517-8,562 mg/24 h) despite receiving an angiotensin-converting enzyme inhibitor (CEI) for at least 4 weeks

Intervention

Losartan 50 mg/d added to baseline CEI therapy for 1 month

Comparator

Baseline measurements on CEI alone

Outcome

Urinary protein excretion (UPE) at 1 monthsurrogate

Adding an ARB to a CEI significantly reduces proteinuria in patients with renal disease, likely due to more complete blockade of tissue angiotensin II.

Discussion

No takes yet. Share an insight, caveat, or question.

Implication

Should not yet change practice for proteinuria; leaves open need for RCTs to confirm renal outcomes.

Cite This Study

Panos et al. (2003) studied this question.

synapsesocial.com/papers/6a6f8cdce36a167817e142b1 https://doi.org/10.5414/cnp60013

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