Optimal antiproteinuric dose of losartan in nondiabetic patients with nephrotic range proteinuria

Although the antiproteinuric response to antihypertensive treatment is the main predictor of renoprotective efficacy in long-term renal disease, to da te, dose-finding studies of anti hypertensives have been based only on bloo d pressure. We aimed to find the optimal antiproteinuric dose of the angiot ensin II antagonist losartan. An open-label, dose-response study using subs equent 6-week treatment periods was performed in 10 nondiabetic patients wi th proteinuria of 5.8 +/- 0.8 g/d and a mean arterial pressure of 103 +/- 3 .7 mm Hg without anti hypertensive medication. All patients had normal to m oderately impaired renal function. After the baseline period, five periods followed with a daily losartan dose of 50 mg, 100 mg, 150 mg, and 50 mg and a recovery without losartan. At the end of each period, proteinuria and me an arterial pressure were measured. The consecutive doses of losartan had a similar anti hypertensive response (-11.3 +/- 2.8% by the 100-mg dose). Th e optimal antiproteinuric response was reached at 100 mg of losartan (-30 /- 8%). The 50-mg dose (-13 +/- 7%) was less effective, and the 150-mg dose (-28 +/- 8%) was not more effective. A 100-mg dose of losartan is optimal for reduction of proteinuria in nondiabetic patients with nephrotic range p roteinuria. (C) 2001 by the National Kidney Foundation, Inc.