Non-immunosuppressive therapy

Non-immunosuppressive therapy
Blocking the renin-angiotensin system (RAS) is a major non-immunosuppressive therapy for IgAN.
Cheng et al. Analyzed 585 patients in 11 RCT studies. Seven of the trials used placebo or no treatment as controls, and four trials used other antihypertensive drugs as controls. Treatment with angiotensin-converting enzyme inhibitors (ACEI) or angiotensin receptor blockers (ARB) had significant renal protective effects and decreased proteinuria compared with the control group.
In a meta-analysis of 109 RCT studies in six RCTs, ACEI and ARB were not superior to ACEI or ARB alone in reducing daily proteinuria, and the risk of hyperkalemia was not increased. The long-term effect of combination therapy on the outcome of the kidney is unknown.
Another meta-analysis included 27 RCTs in a total of 1,577 patients with ACEI, ARB or a combination of both vs other antihypertensives, other drugs, or placebo. The results showed that the benefit of blocking RAS appeared to be greater than that of IgAN The patient's harm. This meta-analysis, however, failed to demonstrate the benefits of using any antihypertensive drug other than to control blood pressure and did not assess major renal and / or cardiovascular end points or long-term mortality risk.
Aliskiren is a relatively new direct oral renin inhibitor (DRI), has been used in the treatment of hypertension and diabetic nephropathy. Tang et al. Recruited 25 patients with IgAN who continued to have persistent proteinuria (24 h urinary protein> 1 g / day) after receiving the largest recommended dose of losartan (100 mg / day) for further treatment with DRI. The albumin / creatinine ratio was reduced by an average of 26% after aliskiren treatment for 12 months, with a 50% reduction in proteinuria in 24% of patients. Treatment with aliskiren significantly reduced plasma renin activity, serum levels of IL-6 and TGF-β. Significantly, transient hyperkalemia was noted in 24% of patients.
Another group of investigators from Hong Kong studied 22 patients with IgAN who had persistent proteinuria despite receiving ACE inhibitors or ARB. Patients were randomized to receive oral aliskiren or placebo for 4 months and then elapsed for another period. After 4-16 weeks of treatment, the aliskiren group had significantly lower levels of proteinuria than placebo. Treatment with aliskiren resulted in moderate but significant reductions in eGFR and systolic blood pressure. No severe hyperkalemia (> 6 mmol / L) was found in these patients.
These two preliminary experiments suggest that aliskiren, a DRI, has a proteinuria effect in patients with IgAN who continue to have proteinuria after receiving ACEI or ARB therapy. Larger RCT studies are also needed to confirm direct suppression of renoprotective renal protection.
RCT evidence is not strong enough to justify the effectiveness of any other non-immunosuppressive treatment, including fish oil, anticoagulant therapy and tonsillectomy.

Author: kidney1234567
Link: http://neph.dxy.cn/article/139675?trace = related
All the text, pictures, audio and video materials on this website, which are marked "Source: Lilac Garden", are copyrighted by Clove Park and may not be reproduced or reproduced in any media, website or individual without authorization. "Source: ".