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KMID : 0338420160310020335
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The Korean Journal of Internal Medicine
2016 Volume.31 No. 2 p.335 ~ p.343
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Effect of low-dose valsartan on proteinuria in normotensive immunoglobulin A nephropathy with minimal proteinuria: a randomized trial
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Jo Young-Il
Na Ha-Young
Moon Ju-Young
Han Sang-Woong
Yang Dong-Ho
Lee Sang-Ho
Park Hyeong-Cheon
Choi Hoon-Young
Lim So-Dug
Kie Jeong-Hae
Lee Yong-Kyu
Shin Sug-Kyun
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Abstract
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Background/Aims: Immunoglobulin A nephropathy (IgAN) is a generally progressive disease, even in patients with favorable prognostic features. In this study, we aimed to investigate the antiproteinuric effect and tolerability of low-dose valsartan (an angiotensin II receptor blocker) therapy in normotensive IgAN patients with minimal proteinuria of less than 0.5 to 1.0 g/day.
Methods: Normotensive IgAN patients, who had persistent proteinuria with a spot urine protein-to-creatinine ratio of 0.3 to 1.0 mg/mg creatinine, were recruited from five hospitals and randomly assigned to either 40 mg of valsartan as the low-dose group or 80 mg of valsartan as the regular-dose group. Clinical and laboratory data were collected at baseline, and at 4, 8, 12, and 24 weeks after valsartan therapy.
Results: Forty-three patients (low-dose group, n = 23; regular-dose group, n = 20) were enrolled in the study. Proteinuria decreased significantly not only in the regular-dose group but also in the low-dose group. The change in urine protein-to-creatinine ratio at week 24 was ?41.3% ± 26.1% (p < 0.001) in the regular-dose group and ?21.1% ± 45.1% (p = 0.005) in the low-dose group. In the low-dose group, blood pressure was constant throughout the study period, and there was no symptomatic hypotension. In the regular-dose group, blood pressure decreased at weeks 8 and 12. No significant change in glomerular filtration rate, serum creatinine level, or serum potassium level was observed during the study period.
Conclusions: Our results suggest that low-dose valsartan can significantly reduce proteinuria without causing any intolerability in normotensive IgAN patients with minimal proteinuria.
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KEYWORD
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Angiotensin receptor antagonists, Glomerulonephritis, IGA, Proteinuria, Safety, Treatment outcome
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