Effects of angiotensin II blockade on nitric oxide blood levels in IgA nephropathy

Background, The effects of renin-angiotensin system blockade on nitric oxid e (NO), especially in pathological conditions, are far from being establish ed. The influence of kinins and angiotensin type 2 receptor are largely spe culative and based mainly on animal studies. This study was aimed to addres s these aspects in humans. Methods. Eight IgA nephropathy patients with documented clinical and histol ogical indicators of poor prognosis were given 50 mg of losartan, 10 mg of enalapril, and 40 mg of the NO donor isosorbide 5 mononitrate (as a control of NO generation) in randomized order for 7 days each. Treatment periods w ere separated by washout periods of 7 days each. Laboratory investigations were performed before and after each study period. Seven healthy controls r eceived losartan and enalapril according to the same study design. Results. Glomerular filtration rate remained stable while effective renal p lasma flow increased with each treatment (P<0.05). Under losartan and enala pril, filtration fraction fell (P=0.02), plasma renin activity increased (P <0.05) and urinary aldosterone concentration decreased (P=0.02). Angiotensi n-converting enzyme activity was reduced to the limit of detection under en alapril (P<0.001). Blood NO, detected as nitrosylhaemoglobin by a recently developed technique of spin-trap electron paramagnetic resonance, increased significantly, as expected, during treatment with isosorbide 5 mononitrate (P=0.01), with enalapril (P<0.05), and also with losartan (P<0.05). Unlike losartan, enalapril significantly reduced albuminuria (P=0.01) in this sho rt-term period. In the seven healthy controls, neither enalapril nor losart an were able to increase blood NO levels significantly. Conclusions. Blood levels of nitrosylhaemoglobin, a surrogate marker of NO, increased under blockade of the renin-angiotensin system in patients with IgA nephropathy, but not in healthy volunteers. This increase could contrib ute to changes of effective renal plasma flow in renal disease states.