Is angiotensin-converting-enzyme inhibition renoprotective in young patiets with IgA nephropathy?  

Oleh:

Li, Philip K.T.

Jenis: Article from Bulletin/Magazine - ilmiah internasional
Dalam koleksi: Medical Progress vol. 34 no. 12 (Dec. 2007), page 578.

Ketersediaan

Perpustakaan FK Nomor Panggil: M36.K.2007.01 Non-tandon: 1 (dapat dipinjam: 0) Tandon: tidak ada

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Isi artikel

BACKGROUND: To investigate the effects of angiotensin-converting enzyme (ACE) inhibition on the progression of renal decline in young patients with IgA nephropathy. DESIGN: The multicenter European, randomized, double-blind IgA Nephropathy and ACE Inhibitors (IgACE) trial enrolled patients aged 3 to 35 years with biopsy-confirmed IgA nephropathy who had proteinuria of 1g/day/1.73m2 to <3.5 g/day/1.73m2, and creatine clearance >50mL/min/1.73m2 throughout the preceding 3 months. Celiac disease and use of steroids or ACE inhibitors in the previous 6 months were among the exclusion criteris. Patients whose proteinuria remained stable during a 3-month run-in phase were randomized to recieve the ACE inhibitors benezepril at 0.2 mg/kg, or placebo, and were followed up at 1 month, 3 months, 6 months and every 4 months thereafter for a total of 3 years. Analysis was by intention to treat. RESULT : A total of 129 patients entered the 3 month run in phase, during the period of November 1998 to December 2003. Proteinuria remained in the range of 1 g/day/1.73 m2 to <3.5 g/day/1.73 m2 in 66 patients (age range 9 to 35 years), of whom 32 underwent randomization to benazepril and 34 to placebo. The two group had similar baseline demographic and clinical characteristics. Median follow-up was 38 months, and 38 patients completed 3 years of follow up. Mean proteinuria decreased significantly from baseline in the benazepril group (p=0.002), but only slightly in the placebo group (p=nonsignificant). Mean creatinine clearance was similar in the two group at baseline, but significantly higher in the benazepril group than in the placebo group at the end of follow up (p=0.03). More placebo treated patients than benazepril treated patients experienced the primary end point of a 30% decrease in creatinine clearance from baseline (5 vs 1; 14.7% vs 3.1%), but the difference in survival free of the primary endpoint did not reach significance (p=0.182). More patients in the placebo group than in the benazepril group experinced one of the endpoints- the composite of a 30% decrease in creatinine clearance or an increase in proteinuria to the nephrotic range (9 vs 1;26.5% vs 3.1%). This difference was significant (p= 0.034). Both partial and complete remission of proteinuria, another secondary endpoint, were more frequent in the benazepril group than in the placebo group (13 vs 3 patients [40.6% vs 8.8%], p=0.0002 and 4 vs 0 patients [12.5%vs 0%], p=0.015). CONCLUSION : ACE inhibition slows the progression of renal dysfunction in young patients with IgA nephropathy and moderate proteinuria.

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