ACE-INHIBITION REDUCES PROTEINURIA IN NORMOTENSIVE PATIENTS WITH IGA NEPHROPATHY - A MULTICENTER, RANDOMIZED, PLACEBO-CONTROLLED STUDY

A multicentre, randomized, placebo-controlled study was performed in 3 9 adult patients with biopsy-proven IgA nephropathy with the aim of co mparing the effects of the ACE inhibitor fosinopril and placebo on pro teinuria. All patients had normal blood pressure and normal renal func tion. Proteinuria ranged from 1.0 to 2.5 g/24 h. After a 3-month run-i n period, fosinopril and placebo were randomly administered in two 4-m onth sequences separated from crossover treatment by a 1-month interva l. The mean values of creatinine clearance did not change during eithe r the placebo or the treatment sequences. The mean values of mean arte rial pressure (MAP) were significantly lower during the fosinopril seq uence (90.4+/-9.0 mmHg) than in basal conditions (92.8+/- 9.1 mmHg) (P =0.034). The mean basal values of proteinuria were 1.74+/-0.84 g/24 h. They were unchanged during the placebo sequence (1.79+/-1.20) and fel l to 1.37+/-0.98 g/24 h after 4 months of fosinopril treatment. Using a multivariate statistical analysis, the treatment effect by time on p roteinuria was significantly evident only in the fosinopril sequence ( Wilks test, P=0.033). Changes in protein excretion were not correlated with changes in MAP, baseline plasma renin activity, and urinary sodi um excretion. This controlled study shows that;fosinopril can signific antly reduce proteinuria even in normotensive patients with IgA nephro pathy. Obviously, the results of treatment with ACE inhibitors on long -term renal prognosis remain to be elucidated.