Lisinopril versus lisinopril and losartan for mild childhood IgA nephropathy: a randomized controlled trial (JSKDC01...

Area of Science:

• Pediatric Nephrology
• Immunology
• Pharmacology

Background:

• Persistent proteinuria is a risk factor for renal disease progression.
• Angiotensin-converting enzyme inhibitors (ACEIs) and angiotensin II receptor blockers (ARBs) reduce proteinuria and offer renoprotection.
• Previous studies suggest combination therapy may be more effective than monotherapy for chronic glomerulonephritis, including IgA nephropathy.

Purpose of the Study:

• To compare the efficacy and safety of lisinopril monotherapy versus combination therapy (lisinopril and losartan) in children with proteinuric mild IgA nephropathy.
• To determine the optimal treatment strategy for childhood proteinuric mild IgA nephropathy.

Main Methods:

• An open-label, multicenter, prospective, randomized phase II controlled trial involving 63 children.
• Patients were randomized to receive either lisinopril monotherapy or combination therapy with lisinopril and losartan.
• The primary endpoint was the proteinuria disappearance rate at 24 months.

Main Results:

• No significant difference in the cumulative proteinuria disappearance rate between the monotherapy and combination therapy groups at 24 months (89.3% vs. 89%).
• No significant differences in reported side effects between the two treatment groups.
• Both lisinopril monotherapy and combination therapy demonstrated high efficacy and safety.

Conclusions:

• Lisinopril monotherapy is a viable and effective treatment for childhood proteinuric mild IgA nephropathy.
• Combination therapy with lisinopril and losartan offers no additional benefit over lisinopril monotherapy in this patient population.
• Lisinopril monotherapy is proposed as the preferred treatment due to its comparable efficacy and safety profile without added complexity.