Key result
In non-diabetic proteinuric CKD patients starting valsartan, urinary protein/creatinine ratio reduction at 6 months was greatest in those with high baseline urinary angiotensinogen (-46.2%).
Why the study?
Does initial urinary angiotensinogen predict the antiproteinuric effect of valsartan in non-diabetic proteinuric CKD patients?
Cohort (n=50)
Does initial urinary angiotensinogen predict the antiproteinuric effect of valsartan in non-diabetic proteinuric CKD patients?
Initial urinary angiotensinogen levels may help predict the antiproteinuric efficacy of angiotensin receptor blockers in non-diabetic CKD patients.
Baseline urinary angiotensinogen may predict valsartan response in non-diabetic proteinuric CKD; hypothesis-generating and requires prospective validation.
OBJECTIVES: Many chronic kidney disease (CKD) patients have persistent overt proteinuria despite angiotensin receptor blocker (ARB) treatment. This study investigated whether the initial difference in intrarenal renin-angiotensin system activity measured with urinary angiotensinogen would affect the antiproteinuric effects of ARB. METHODS: Between September 2005 and September 2008, in 50 non-diabetic proteinuric CKD patients not taking renin-angiotensin system inhibitors, the urinary protein/creatinine ratio (P/Cr), angiotensinogen/creatinine ratio (AGT/Cr), plasma renin and aldosterone were measured before starting valsartan, and were followed for 18 months. RESULTS: Patients were divided into three groups according to their initial urinary AGT/Cr. The urinary P/Cr was lower in the low angiotensinogen group, but similar in the high and extremely high angiotensinogen groups (1.3±0.38 vs 2.0±0.92 vs 2.2±0.78). In all groups, the urinary P/Cr was decreased most for the first 6 months. The urinary P/Cr reduction at 6 months was greatest in the high angiotensinogen group (-24.2% vs -46.2% vs -16.4%). The urinary AGT/Cr was decreased most in the high angiotensinogen group. Renal functional deterioration was attenuated in the high angiotensinogen group compared with the extremely high angiotensinogen group. CONCLUSIONS: The antiproteinuric effects of ARB were different according to the initial urinary angiotensinogen levels. These results suggest the potential value of the initial urinary AGT/Cr for predicting the therapeutic effect of ARB in proteinuric non-diabetic CKD patients.
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Jang et al. (2012) conducted a cohort in Non-diabetic proteinuric chronic kidney disease (n=50). Initial urinary angiotensinogen/creatinine ratio (AGT/Cr) vs. Low and extremely high initial urinary AGT/Cr was evaluated on Urinary protein/creatinine ratio (P/Cr) reduction at 6 months. In non-diabetic proteinuric CKD patients starting valsartan, urinary protein/creatinine ratio reduction at 6 months was greatest in those with high baseline urinary angiotensinogen (-46.2%).
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