Key result
Intensified triple RAS blockade with ramipril, candesartan, and aliskiren produced a significant and sustained antiproteinuric effect and was well tolerated over 12 months in a patient with recurrent FSGS.
Why the study?
Does intensified triple RAS blockade with ramipril, candesartan, and aliskiren improve proteinuria in a patient with recurrent FSGS after renal transplantation?
Case Report (n=1)
Does intensified triple RAS blockade with ramipril, candesartan, and aliskiren improve proteinuria in a patient with recurrent FSGS after renal transplantation?
Triple RAS blockade with ramipril, candesartan, and aliskiren may offer a therapeutic approach for reducing proteinuria in selected hypertensive patients with recurrent FSGS after kidney transplantation.
May support triple RAS blockade for proteinuria in recurrent post-transplant FSGS; hypothesis-generating and requires prospective confirmation.
Recurrent focal segmental glomerulosclerosis (FSGS) after renal transplantation with nephrotic syndrome is a serious problem with a high risk of graft loss. The therapeutic role of renin-angiotensin-system (RAS) blockers in recurrent FSGS is not clear. We present the safety and efficacy of an intensified triple RAS blockade with an ACE-inhibitor, an AT 1 receptor blocker and the direct renin inhibitor aliskiren in a 29-year-old renal transplant recipient with biopsy proven recurrence of FSGS and relapsing severe nephrotic syndrome. We subsequently used full dose ramipril, candesartan and aliskiren under a close monitoring of kidney function and electrolytes and examined the effect on proteinuria, clinical course and tolerability over 12 months. We found a significant and sustained antiproteinuric effect under triple RAS blockade. RAS blockade was generally well tolerated. This can offer a new therapeutic approach in selected hypertensive patients with recurrent FSGS.
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Freiberger et al. (2009) conducted a case report in Recurrent focal segmental glomerulosclerosis (FSGS) after kidney transplantation (n=1). Intensified triple RAS blockade (ramipril, candesartan, and aliskiren) was evaluated on Proteinuria, clinical course, and tolerability. Intensified triple RAS blockade with ramipril, candesartan, and aliskiren produced a significant and sustained antiproteinuric effect and was well tolerated over 12 months in a patient with recurrent FSGS.
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