A RANDOMIZED PROSPECTIVE COMPARISON OF NADOLOL, CAPTOPRIL WITH OR WITHOUT TICLOPIDINE ON DISEASE PROGRESSION IN IGA NEPHROPATHY

To determine if angiotensin converting enzyme inhibitors (ACEI) and an tiplatelet agents have any added advantages over beta-blockers in prev enting disease progression in IgA nephropathy (IgAN), 52 patients with IgAN with at least two features suggestive of progressive disease, na mely, proteinuria >1 gm/ day, mean blood pressure (MBP)>107 mmHg, seru m creatinine 0.12-0.4 mmol/L and the presence of glomerulosclerosis an d/or tubulointerstitial fibrosis on initial biopsy were randomized to receive nadolol (N), captopril (C) and captopril plus ticoplidine (CT) . In hypertensive subjects, the dose N and C was adjusted to normalize MBP In normotensive subjects the dose was adjusted to achieve a reduc tion of MBP of 5-10 mmHg. Five patients withdrew prematurely before re aching the end of the study period. The results after a minimal period of 3 years follow-up were available in the remaining 47 patients (n=1 6, 12 and 19 in groups N, C and CT, respectively). Target of blood pre ssure (BP) treatment was achieved in all patients and the post-treatme nt MBP was comparable among the three groups. In C and CT, peripheral blood renin increased significantly while in CT, in vitro platelet agg regation decreased significantly following treatment. Urinary protein and albumin excretion decreased significantly in all treatment groups but there was no difference among the three groups. Progression of ren al failure as measured by life table analysis of the percentage of pat ients with doubling of serum creatinine and by the slope of the recipr ocal of serum creatinine (mean+/-SEM: -0.021+/-0.014; -0.016+/-0.010 a nd -0.017+/-0.008 for N, C and CT, respectively) and of glomerular fil tration rate as measured by plasma disappearance of injected Cr(51)EDT A over time (mean +/- SEM: -0.556 +/- 0.157, - 0.739 +/- 0.304 and -0. 54 3 +/- 0.274 for N, C and CT) were similar among the three groups. I n this small comparative study, ACEI does not appear to be better than long acting betablocker in retarding disease progression in patients with IgAN and ticlopidine confers no additional benefit.