LOW-DOSE ANGIOTENSIN-CONVERTING-ENZYME INHIBITOR CAPTOPRIL TO REDUCE PROTEINURIA IN ADULT IDIOPATHIC MEMBRANOUS NEPHROPATHY - A PROSPECTIVE-STUDY OF LONG-TERM TREATMENT

The objective of this trial was to determine the long-term antiprotein uric effect of a low-dose of the angiotensin-converting-enzyme inhibit or (ACEI) captopril in patients with idiopathic membranous nephropathy (IMN), stable renal function, and no indicators of poor long-term pro gnosis. Fourteen adult IMN outpatients (median age 53 years) with a me dian duration of disease of 3 years received 12.5 mg of captopril twic e a day for 12 months in a prospective trial. The effects of therapy w ere evaluated on the basis of plasma creatinine, 24-h proteinuria, the proteinuria selectivity index, albuminaemia, and serum IgG levels. Da ta were compared by means of the non-parametric paired Wilcoxon test. Three patients withdrew from the trial. Renal function remained stable in the 11 who completed the study. A clear decrease in proteinuria wa s observed after 1 month of therapy, which persisted with time and was associated with a trend towards a further long-term decrease. An incr ease in serum albumin was only observed after 6 months of therapy, aga in with a trend towards an increase over time. Serum IgG levels increa sed during therapy. This study together with data from the literature suggests a potential long-term benefit of angiotensin-converting-enzym e inhibitors in moderately proteinuric IMN. Prospective trials compari ng low-dose and high-dose ACEI to no treatment or a placebo in non-sev ere IMN are now required.