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document
Low-dose angiotensin II receptor antagonists and angiotensin II-converting enzyme inhibitors alone or in combination for treatment of primary glomerulonephritis . OBJECTIVE The renin-angiotensin system is thought to be involved in the progression of chronic renal diseases of both diabetic and non-diabetic origin . It has been confirmed that angiotensin-converting enzyme inhibitors ( ACEIs ) and angiotensin II receptor blockers ( ARBs ) reduce urinary protein excretion and attenuate the development of renal injury . Clinical data comparing the renal effects of ACEIs and ARBs , either singly or in combination , are scarce and usually concern the use of standard or high doses . MATERIAL AND METHODS This was a prospective , randomized , 9-month study of the effects of low doses of losartan ( 25 mg ; n = 18 ) versus enalapril ( 10 mg ; n = 18 ) versus the combination of losartan ( 25 mg ) and enalapril ( 10 mg ) ( n = 16 ) on proteinuria , kidney function and metabolic profile in 54 patients with biopsy-proven chronic glomerulonephritis , hypertension and normal or slightly impaired kidney function . The clinical evaluation and laboratory tests were performed before treatment ( baseline ) and after 3 and 9 months of therapy . RESULTS After 3 months , significant decreases in proteinuria were observed in all groups : losartan , 22.6 % ( p = 0.02 ) ; enalapril , 43 % ( p = 0.012 ) ; and combined therapy , 63 % ( p = 0.001 ) . This anti-proteinuric effect was even greater after 9 months of therapy : losartan , 44.2 % ( p = 0.02 ) ; enalapril , 49.6 % ( p = 0.02 ) ; and combined therapy , 51 % ( p = 0.003 ) . There was no significant difference between losartan and enalapril with respect to their impact on proteinuria level . Proteinuria reduction was significantly greater in patients receiving combined therapy in comparison with losartan treatment after 3 months of therapy ( p = 0.02 ) . Creatinine clearance and serum creatinine were stable during the entire study period in all patients . No significant changes in lipids , serum uric acid or protein levels were observed . CONCLUSIONS These results indicate that proteinuria is reduced by low doses of losartan or enalapril . The combination of these drugs seems to be beneficial and may offer an additional renoprotective effect . This needs to be confirmed in a study with a larger sample size .
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Intervention_Control
Low-dose angiotensin II receptor antagonists and angiotensin II-converting enzyme inhibitors alone or in combination
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Intervention_Pharmacological
losartan
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Intervention_Pharmacological
enalapril
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Intervention_Pharmacological
combination of losartan ( 25 mg ) and enalapril
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Outcome_Physical
proteinuria , kidney function and metabolic profile
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Outcome_Physical
clinical evaluation and laboratory tests
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Outcome_Physical
proteinuria
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Outcome_Physical
anti-proteinuric effect
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Outcome_Physical
proteinuria
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Outcome_Physical
Proteinuria reduction
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Outcome_Physical
Creatinine clearance and serum creatinine
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Outcome_Physical
changes in lipids , serum uric acid or protein levels
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Participant_Condition
chronic glomerulonephritis
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Participant_Condition
hypertension
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Participant_Condition
impaired kidney function