What is the role of renin-angiotensin blockade in the treatment of immunoglobulin A (IgA) nephropathy?

Updated: May 19, 2020
  • Author: Sohail Abdul Salim, MD, FASN, FACP; Chief Editor: Vecihi Batuman, MD, FASN  more...
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Answer

Angiotensin-converting enzyme inhibitors (ACEIs) or angiotensin receptor blockers (ARBs) are the preferred agents for lowering blood pressure and decreasing proteinuria. [27]  In a randomized, controlled trial in 44 patients with biopsy-proven IgA nephropathy who had proteinuria and normal or moderately reduced renal function, Kaplan-Meier renal survival after 7 years was 92% in patients treated with enalapril versus 55% in the control group (P < 0.05). [28]  

Results of a prospective, open-label, multicenter, centrally randomized, controlled trial in 97 patients suggested that the combination of the ACEI ramipril with prednisone was more effective than ramipril alone in discouraging progression of renal disease associated with IgA nephropathy. [29]  The combination of an ACEI with an ARB is used by some clinicians, especially if serum creatinine is monitored cautiously, but this approach is not supported by randomized controlled trial data; although it decreases proteinuria, it is associated with greater risk of acute kidney injury and hyperkalemia. 


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