ACE inhibition reduces proteinuria in normotensive patients with IgA nephropathy: a multicentre, randomized, placebo-controlled study

A multicentre, randomized, placebo-controlled study was performedin 39 adult patients with biopsy-proven IgA nephropathy withthe aim of comparing the effects of the ACE inhibitor fosinopriland placebo on proteinuria. All patients had normal blood pressureand normal renal function. Proteinuria ranged from 1.0 to 2.5g/24 h. After a 3-month run-in period, fosinopril and placebowere randomly administered in two 4-month sequences separatedfrom crossover treatment by a 1-month interval. The mean valuesof creatinine clearance did not change during either the placeboor the treatment sequences. The mean values of mean arterialpressure (MAP) were significantly lower during the fosinoprilsequence (90.4 ±9.0 mmHg) than in basal conditions (92.8± 9.1 mmHg) (P=0.034). The mean basal values of proteinuriawere 1.74 ±0.84 g/24 h. They were unchanged during theplacebo sequence (1.79 ±1.20) and fell to 1.37 ±0.98g/24 h after 4 months of fosinopril treatment. Using a multivariatestatistical analysis, the treatment effect by time on proteinuriawas significantly evident only in the fosinopril sequence (Wilkstest, P=O.O33). Changes in protein excretion were not correlatedwith changes in MAP, baseline plasma renin activity, and urinarysodium excretion. This controlled study shows that fosinoprilcan significantly reduce proteinuria even in normotensive patientswith IgA nephropathy. Obviously, the results of treatment withACE inhibitors on long-term renal prognosis remain to be elucidated.