Effects of co-administration of urokinase and benazepril on severe IgA nephropathy.

BACKGROUND: The availability of treatment for IgA nephropathy (IgAN) is limited. Method. A prospective randomized controlled clinical trial was performed to evaluate the effects of therapy with urokinase (UK) and benazepril (BZ, an angiotensin-converting enzyme inhibitor) or BZ alone on severe IgAN. We divided 71 cases of IgAN, Lee's grade >/=III and with fibrinogen deposits, into two groups to be treated for 12 months with either UK + BZ or BZ alone. RESULTS: There was no significant difference between the two groups in baseline clinical and histopathological data. After 12 months of treatment, 25 of 35 patients (71.4%) in the UK + BZ group and 16 of 36 (44.4%) in the BZ-alone group had a >/=50% decrease in 24-h urinary protein excretion compared with the baseline (chi(2) test, P<0.05). Proteinuria significantly decreased at 6 and 12 months of treatment in both groups compared with baseline (P<0.01 in the UK + BZ group, P<0.05 in the BZ group), and the therapeutic efficiency of UK + BZ was better than that of BZ alone (P<0.05 at 6 and 12 months). The endogenous creatinine clearance rate (Ccr) was stable in the UK + BZ group, while Ccr declined significantly at 6 and 12 months in the BZ-alone group compared with baseline (P<0.05, respectively). The Ccrs of the two groups at 12 months of treatment were statistically different (P<0.05). CONCLUSIONS: Combined therapy with UK and BZ was more effective than with BZ alone in reducing proteinuria and protecting renal function in patients with severe IgAN.