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The Mycophenolate Steroids Sparing (MYSS) study found that in renal transplant recipients who were on immunosuppressive therapy with the cyclosporine microemulsion Neoral, mycophenolate mofetil (MMF) was not better than azathioprine in preventing acute rejection at 21 mo after transplantation and was 15 times more expensive ; P ‫؍‬ 0.53), and adverse events were similar on azathioprine (n ‫؍‬ 124) and MMF (n ‫؍‬ 124), respectively. Outcomes in the two groups were comparable also among patients with or without steroid therapy, considered separately. In kidney transplantation, the long-term risk/benefit profile of MMF and azathioprine therapy in combination with cyclosporine Neoral is similar. In view of the cost, standard immunosuppression regimens for kidney transplantation should perhaps include azathioprine rather than MMF.

Pretreatment blood pressure reliably predicts progression of times after treatment administration are questionable. chronic nephropathies. Background. Random, nontimed blood pressure (BP) measurements in the outpatient clinic may fail to provide reliable information on actual daily BP control in renal patients on Progressive renal function deterioration occurs in most chronic antihypertensive therapy. forms of chronic nephropathy [1]. A recognized major Methods. In a cohort of 163 patients with proteinuric chronic nephropathies followed prospectively with repeated BP and determinant of renal injury in these circumstances is glomerular filtration rate (GFR) measurements, we compared arterial hypertension: the higher the levels of arterial baseline and follow-up pretreatment, morning ("trough," meablood pressure (BP), the greater the risk of a given pasured by standard procedures, and "0 minutes," measured by tient to develop renal failure in the long term [2, 3]. an automatic device) and post-treatment (120 minutes) mea-On the other hand, many clinical studies are available surements, with BP monitored up to 600 minutes after treatment administration. We then evaluated which BP value most indicating that BP reduction is protective [reviewed in reliably predicted GFR decline (⌬GFR) and progression to 4]. In most intervention trials aimed at evaluating the end-stage renal failure (ESRF) over a median (interquartile effect of different antihypertensive regimens on disease range) follow-up of 20 (9 to 25) months. progression to renal failure, reported values of arterial Results. GFR decline was more reliably predicted by systolic BP were random measurements in outpatient clinics, as compared with diastolic BP and by pretreatment as compared to post-treatment BP, regardless of the timing and which may lead to different results depending on the method of measurement, respectively. In particular, at the 120time BP is measured [5-8]. Actually, in some studies, minute baseline and follow-up measurements, systolic BP had BP was measured in the morning just before the adminisno predictive value in patients with less severe renal insuffitration of antihypertensive medication, when the residciency and baseline diastolic BP, regardless of the level of renal dysfunction. The BP predictive value was remarkably higher ual effect of treatment is minimal ("trough" BP) [9-11]. in ramipril than in conventionally treated patients. All follow-In a few others, the BP was measured shortly after the up-but no baseline-measurements reliably predicted the risk administration of the antihypertensive treatment, conof ESRF in the entire study group. ceivably when the medication has achieved the peak Conclusions. In patients with progressive chronic nephropaeffect [12]. However, most of the studies did not report thies, systolic BP and pretreatment morning BP measurements are the most reliable predictors of disease outcome and may the timing of BP measurements [5-8], which renders data serve to guide antihypertensive therapy in routine clinical ...

In patients with progressive chronic nephropathies, systolic BP and pretreatment morning BP measurements are the most reliable predictors of disease outcome and may serve to guide antihypertensive therapy in routine clinical activities and in prospective controlled trials, particularly in patients on angiotensin-converting enzyme inhibitor therapy. Reliability and relevance of single measurements taken at different times after treatment administration are questionable.