Preventing End Stage Renal Disease with Combination Drug Treatment in Patients with IgA Nephropathy

A combination of steroids and a blood pressure-lowering drug better prevents end stage renal disease (ESRD) than a blood pressure-lowering drug alone, researchers suggest.

IgA nephropathy (IgAN) is a form of inflammation in the kidneys and is the most common cause of chronic renal failure. Recent studies have shown that steroids improve renal survival and reduce excess protein in the urine in IgAN individuals with moderate protein in the urine and normal renal function. Moreover, long-term use of the blood pressure-lowering ACE inhibitors (ACEi) has been shown to reduce the risk of ESRD in IgAN individuals with excess protein in the urine.

“This new study shows that a definite therapeutic approach has been established for IgAN patients,” said Francesco Schena, MD, FASN, professor of nephrology at the University of Bari, in Bari, Italy, and chief of the research group conducting the study.

Researchers assessed whether the combination of the oral steroid prednisone and the blood pressure-lowering drug ramipril is more effective in individuals with IgAN than ramipril alone. Forty-eight individuals received the prednisone plus ramipril, while 49 individuals received ramipril only.

Fewer individuals receiving prednisone plus ramipril developed ESRD (2.1 percent) than did individuals receiving only ramipril (16.3 percent), after eight years. Individuals receiving combination treatment also had better renal survival (97.7 percent) than individuals receiving only ramipril (69.9 percent) in the long-term follow-up.

The findings from the study, “Long-Term Prospective Randomized Controlled Multicenter Trial on Steroids Plus Ramipril in Proteinuric IgA Nephropathy,” were presented as part of the Renal Week session on late-breaking clinical trials.