Effect of low-dose valsartan on proteinuria in normotensive immunoglobulin A nephropathy with minimal proteinuria: a randomized trial

Young-Il Jo, Ha-Young Na, Ju-Young Moon, Sang-Woong Han, Dong-Ho Yang, Sang-Ho Lee, Hyeong-Cheon Park, Hoon-Young Choi, So-Dug Lim, Jeong-Hae Kie, Yong-Kyu Lee, Sug-Kyun Shin, Young-Il Jo, Ha-Young Na, Ju-Young Moon, Sang-Woong Han, Dong-Ho Yang, Sang-Ho Lee, Hyeong-Cheon Park, Hoon-Young Choi, So-Dug Lim, Jeong-Hae Kie, Yong-Kyu Lee, Sug-Kyun Shin

Abstract

Background/aims: Immunoglobulin A nephropathy (IgAN) is a generally progressive disease, even in patients with favorable prognostic features. In this study, we aimed to investigate the antiproteinuric effect and tolerability of low-dose valsartan (an angiotensin II receptor blocker) therapy in normotensive IgAN patients with minimal proteinuria of less than 0.5 to 1.0 g/day.

Methods: Normotensive IgAN patients, who had persistent proteinuria with a spot urine protein-to-creatinine ratio of 0.3 to 1.0 mg/mg creatinine, were recruited from five hospitals and randomly assigned to either 40 mg of valsartan as the low-dose group or 80 mg of valsartan as the regular-dose group. Clinical and laboratory data were collected at baseline, and at 4, 8, 12, and 24 weeks after valsartan therapy.

Results: Forty-three patients (low-dose group, n = 23; regular-dose group, n = 20) were enrolled in the study. Proteinuria decreased significantly not only in the regular-dose group but also in the low-dose group. The change in urine protein-to-creatinine ratio at week 24 was -41.3% ± 26.1% (p < 0.001) in the regular-dose group and -21.1% ± 45.1% (p = 0.005) in the low-dose group. In the low-dose group, blood pressure was constant throughout the study period, and there was no symptomatic hypotension. In the regular-dose group, blood pressure decreased at weeks 8 and 12. No significant change in glomerular filtration rate, serum creatinine level, or serum potassium level was observed during the study period.

Conclusions: Our results suggest that low-dose valsartan can significantly reduce proteinuria without causing any intolerability in normotensive IgAN patients with minimal proteinuria.

Keywords: Angiotensin receptor antagonists; Glomerulonephritis, IGA; Proteinuria; Safety; Treatment outcome.

Conflict of interest statement

No potential conflict of interest relevant to this article was reported.

Figures

Figure 1.
Figure 1.
Flow diagram of low-dose and regular-dose valsartan treatment in normotensive immunoglobulin A nephropathy patients presenting with minimal proteinuria. The diagram shows a multicenter trial with a randomized allocation.
Figure 2.
Figure 2.
Changes in urinary protein-to-creatinine ratio over time following administration of valsartan in normotensive immunoglobulin A nephropathy patients presenting with minimal proteinuria. ap < 0.05 vs. baseline.
Figure 3.
Figure 3.
Effects on systemic blood pressure following administration of valsartan 40 or 80 mg in normotensive immunoglobulin A nephropathy patients presenting with minimal proteinuria. SBP, systolic blood pressure; DBP, diastolic blood pressure. ap < 0.05 vs. baseline SBP/DBP on the low-dose group (valsartan 40 mg). bp < 0.05 vs. baseline SBP of the regular-dose group (valsartan 80 mg).

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