Comparison of Steroids and Angiotensin Receptor Blockers for Patients with Advanced IgA Nephropathy and Impaired Renal Function

Abstract

Background/Aims: The therapeutic strategy for advanced IgA nephropathy patients with impaired renal function is still controversial. Patients and Methods: We divided 44 IgA nephropathy patients with an estimated glomerular filtration rate (eGFR) of less than 60 ml/min/1.76 m² and proteinuria greater than 0.5 g/g · creatinine into two groups: the angiotensin receptor blocker (ARB) group (n = 22), treated with ARBs, and the steroid group (n = 22), treated with corticosteroid. We analyzed the clinical and histological background, renal survival rate until progression to end-stage renal disease (ESRD), and the risk factors for progression. Results: The clinical and histological backgrounds were not significantly different between the groups. At 1 and 2 years after treatment, proteinuria tended to be decreased from baseline in both groups, but not significantly, and urinary red blood cells were significantly decreased in the steroid groups (p < 0.001), but not in the ARB group. The eGFR tended to be increased in the steroid group and decreased in the ARB group. However, the renal survival rate until ESRD was not significantly different between the groups. There were no significant independent risk factors for progression. Conclusion: The beneficial effect of ARBs on renal survival of advanced IgA nephropathy with impaired renal function is equal to that with steroids.

Effects of Combination Therapy with Renin-Angiotensin System Inhibitors and Eicosapentaenoic Acid on IgA Nephropathy

“…For example, the number of advanced cases involving T2 and T3 in the Oxford analysis tended to be higher in the DILAZEP group, and the ACEI/ARB ratio was also higher in the DI-LAZEP group. In our previous reports, we demonstrated the long-term beneficial effects of RASIs on the prevention of end-stage renal disease; however, we could not show any effects causing significant decreases in the levels of U-Prot in the advanced IgAN cases (20,21), and the decreases in the levels of U-Prot caused by ARBs were greater than those caused by ACEIs in these cases (19). In addition, we could not deny that these differences between the groups accounted for the lack of significant decreases in the levels of U-Prot in the DILAZEP group, although the ability of RASIs to decrease the levels of U-Prot is widely recognized.…”

“…Several previous reports from various countries have facilitated a full understanding of the renoprotective effects of RASIs (11)(12)(13). Results from our laboratory have also demonstrated the beneficial effects of these medications, especially in patients with advanced IgAN with an impaired renal function (19)(20)(21), a condition for which fish oil therapies, including the omega-3 polyunsaturated fatty acids (PUFA) eicosapentaenoic acid and docosahexaenoic acid (DHA), are also beneficial, as reported by several groups (22)(23)(24)(25). In an elegant series of studies, Donadio and colleagues reported the short-and long-term beneficial effects of fish oil on IgAN using a randomized controlled trial.…”

Advanced IgA nephropathy with impaired renal function benefits from losartan treatment in rats

“…16 It was reported that ACEI/ARB was effective as same as steroids for longterm renal survival of advanced IgAN. 20 However, the beneficial effects of ACEI/ARB on advanced IgAN were independent of the reduction of proteinuria and blood pressure. 19 The histological findings of the renal biopsy specimens showed approximately 65% of all IgAN patients weeks, TGF-b1, FN, a-SMA and FGF-1 expressions in the model group were significantly up-regulated as compared with the control group (p50.05).…”

“…20 Steroids or immunosuppressive agents can repair active lesions, but does not affect chronic lesions and the remaining glomeruli with glomerular hypertension and hyperfiltration. Although ARB therapy does not affect active lesions, it can reduce glomerular hypertension and hyperfiltration of the remaining glomeruli.…”

“…18 Moreover, ACEIs or ARBs had beneficial effect equal to that with steroids for long-term renal survival of advanced IgAN, although proteinuria and blood pressure did not decrease. 19,20 According to the above results, we hypothesized that that ACEI/ARB treatment would play a beneficial role in renal pathological changes of advanced IgAN. Therefore, the present study was conducted to investigate the effect of losartan on advanced IgAN induced by staphylococcal enterotoxin B (SEB) 21 combined with 5/6 nephrectomy in rats.…”