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[Comparison of ARB and ACEI for renoprotection in chronic glomerulonephritis]
Hiroo Kumagai1, Katsufumi Sakata, Tomokazu Matsuura
1Department of Internal Medicine, Keio University School of Medicine.
Insights
Candesartan, an angiotensin II receptor blocker, significantly reduced proteinuria more than an ACE inhibitor in patients with chronic glomerulonephritis. Both drugs showed renoprotective effects, with candesartan offering greater aldosterone suppression.
Area of Science:
- Nephrology
- Pharmacology
- Internal Medicine
Background:
- Chronic glomerulonephritis often leads to moderate renal impairment.
- Angiotensin II receptor blockers (ARBs) and ACE inhibitors (ACEIs) are used to manage hypertension and proteinuria in kidney disease.
Purpose of the Study:
- To compare the efficacy of candesartan (an ARB) versus an ACEI in reducing proteinuria and preserving renal function.
- To investigate the effects of these drugs on hormonal markers like plasma aldosterone concentration (PAC) and plasma renin activity (PRA).
Main Methods:
- A 1.5-year prospective study involving 44 patients with moderate renal impairment due to chronic glomerulonephritis.
- Patients were randomized to receive either candesartan (n=21) or an ACEI (n=23).
- Evaluated proteinuria, serum creatinine, serum potassium, PAC, and PRA at baseline and follow-up points.
Main Results:
- Both candesartan and ACEI comparable blood pressure reduction.
- Candesartan demonstrated a significantly greater reduction in proteinuria compared to ACEI (p < 0.01).
- Neither drug increased serum creatinine, indicating renoprotective effects. Candesartan showed stronger suppression of PAC and PRA compared to ACEI.
Conclusions:
- Candesartan is more effective than ACEI in reducing proteinuria in patients with chronic glomerulonephritis and moderate renal impairment.
- The superior efficacy of candesartan may be linked to its greater suppression of the renin-angiotensin-aldosterone system.
- Both drug classes appear renoprotective, but candesartan's effect on aldosterone suggests potential benefits in mitigating mesangial matrix expansion and fibrosis.
Abstract:
This 1.5-year prospective study compared the effects of angiotensin II receptor blocker, candesartan(n = 21), and ACE inhibitor(ACEI, n = 23) on proteinuria and renal function in patients with moderate renal impairment due to chronic glomerulonephritis. Blood pressure reductions were comparable between both groups. Proteinuria was significantly reduced from 2.1 +/- 0.4 (mean +/- SE) to 0.6 +/- 0.2 g/day(p < 0.001) with candesartan, and the reduction was significantly larger than with ACEI(p < 0.01). Serum creatinine did not increase with candesartan or ACEI, suggesting the renoprotective effect. Serum potassium increased significantly with both drugs from 6 months. Plasma aldosterone concentrations(PAC) showed a stronger suppression with candesartan(150 pg/ml before treatment and 51 at 1.5 years) than with ACEI(104 pg/ml at 1.5 years). Plasma renin activity with candesartan(1.0 ng/ml/hr before treatment) decreased from 3.9 ng/ml/hr at 6 months to 1.3 at 1.5 years, whereas PRA remained elevated with ACEI. We speculate that the stronger reduction of PAC contributed to suppression of growth of mesangial matrix and the interstitial fibrosis in the candesartan group.