Additive Antiproteinuric Effect of Combination Therapy with ACE Inhibitor and Angiotensin II Receptor Antagonist: Differential Short-term Response between IgA Nephropathy and Diabetic Nephropathy

Renal effects of dual renin–angiotensin–aldosterone system blockade in patients with diabetic nephropathy

“…Evidence from short-term studies indicates that combined therapy with ACEI and ARB results in a more complete blockade of RAS than monotherapy, and reduces proteinuria [30][31][32][33][34][35][36][37][38][39][40][41][42]. However most of these trials included a small number of patients and are heterogeneous with important differences in the doses of medications used; individual response to dual blockade therapy is, moreover, variable.…”

“…In contrast with this results Kim et al [37] undertook a crossover trial of combination therapy in two selected homogenous groups of patients: 24 type 2 diabetic patients with DN and 19 patients with non-diabetic renal diseases (IgA nephropathy). Candesartan 4 mg (once daily) was administered in addition to ramipril, for 12 weeks.…”

“…The effect of dual blockade of RAS in patients with diabetes has been investigated only in short-term studies, often with surrogate end points for progression of DN, for example antiproteinuric effects [30][31][32][33][34][35][36][37][38][39][40][41][42] (Table 1).…”

Drug and Diabetic Nephropathy

“…On the other hand, the addition of Losartan 50 mg daily for one month did not improve proteinuria in 16 obese, hypertensive patients (12 with diabetic nephropathy) with moderately advanced renal failure and heavy proteinuria (mean urinary protein 3.8 g/day) 113 . A Korean group also reported no beneficial effect on proteinuria when candesartan was added to ramipril therapy in type 2 diabetic patients with nephropathy despite the positive anti-proteinuric effect seen in patients with IgA nephropathy following the same regimen 114,115 .…”

Rationale for Combination Angiotensin Receptor Blocker and Angiotensin-Converting Enzyme Inhibitor Treatment and End-Organ Protection in Patients with Chronic Kidney Disease

“…In a 12-week study directly comparing the effect of combining ARB and ACE inhibitor therapy in patients with IgA nephropathy versus diabetic nephropathy, the addition of candesartan to ramipril therapy had an additional antiproteinuric effect only in those with IgA nephropathy [40]. In a 16-week study conducted by the same group, addition of candesartan to ramipril therapy reduced urinary protein and transforming growth factor-β 1 levels in subjects with IgA but not those with diabetic nephropathy [41].…”