For young patients with the kidney disease IgA nephropathy (IgAN), early treatment with angiotensin-converting enzyme (ACE) inhibitors can reduce the long-term risk of irreversible kidney damage, suggests a study in the June Journal of the American Society of Nephrology.
"These results in young patients are of particular interest because they could offer a way of limiting the future need for renal replacement therapy in patients with IgAN," comments Dr. Rosanna Coppo of Regina Margherita Hospital in Turin, Italy, lead author of the new study.
In the European cooperative study (supported by EU Community), 66 children and young adults with early-stage IgAN were randomly assigned to treatment with the ACE inhibitor benazepril or an inactive placebo. IgA nephropathy is caused by deposits of the protein IgAan immune system antibodywithin the filtering units of the kidney (glomeruli). The abnormal IgA deposits damage the glomeruli, leading to blood and protein in the urine. The disease can progress over time, eventually requiring dialysis or transplantation to replace lost kidney function.
Favorable effects have been reported using corticosteroids, which can reduce proteinuria and decline of renal function. However, there are concerns about using steroids at high doses or for prolonged periods, particularly in children and young subjects. The patients in the study all had relatively mild disease, with normal or near-normal kidney function and only mildly elevated levels of protein in the urine. "Our trial focused on a subset of patients with a sort of 'pure' IgAN, without the confounding effects of aging or environmental toxic exposures, including smoking and alcohol, and without severe high blood pressure," says Dr. Coppo.
After a median three years of treatment, the rate of decreased kidney function was just three percent for patients treated with the ACE inhibitor, compared to fifteen percent in the placebo group. The combine
Contact: Shari Leventhal
American Society of Nephrology