Slowing nephropathy progression: focus on proteinuria reduction

Abstract

Blood pressure control reduces decline of kidney function. Angiotensin-converting enzyme inhibitors and angiotensin receptor blockers offer renoprotection to a small extent beyond that attributable to blood pressure lowering. These agents also reduce proteinuria, a risk marker for renal disease progression. Accumulating evidence indicates that their antiproteinuric effect correlates with their additional renal benefits.

Figure 1.

Early proteinuria change predicts long-term renal decline. Correlation between early (1 mo after randomization) percentage change in urinary protein excretion from baseline and long-term (>6 mo after randomization) rate of GFR decline among 36 patients who received ramipril in the high-proteinuria (baseline ≥3 g/d) group. Reprinted from reference (13), with permission.

Figure 2.

Six-month change in proteinuria predicts risk for ESRD. Relationship between the risk for ESRD and initial change in proteinuria. The relative risk for ESRD during follow-up for different subgroups, defined by the change in the urine protein-to-creatinine ratio (UP:Cr) from baseline to 6 mo and controlling for randomized treatment group and the initial level of proteinuria, is shown. The reference group ranges from a 20% reduction in UP:Cr to a 25% increase. The cutoff values that define the change-in-proteinuria subgroups correspond to percentage changes that are symmetric on the log scale. Error bars represent SE. Reprinted from reference (4), with permission.

Figure 3.

Combination angiotensin-converting enzyme inhibitor (ACEI)/angiotensin II receptor blocker (ARB) reduced risk for renal end point versus ACEI or ARB. Effect of losartan plus trandolapril compared with the effect of either agent alone on end point (time to doubling of serum creatinine or ESRD). Patients did not have diabetes and had hypertension and chronic nephropathy. Reprinted from reference (17), with permission.