Treatment of Early Immunoglobulin A Nephropathy by Angiotensin-converting Enzyme Inhibitor

BACKGROUND: The treatment of immunoglobulin A (IgA) nephropathy with normal renal function and minimal proteinuria is unknown. METHODS: We randomly assigned 60 patients with IgA nephropathy, proteinuria <0.5 g/day, normal blood pressure and renal function to ramipril 2.5 mg daily or no treatment. Patients were followed for 5 years for the development of hypertension, proteinuria, or impaired renal function. RESULTS: The blood pressure of the treatment group was marginally lower than the control group throughout the study period. At 60 months, the event-free survival was marginally higher for the treatment group as compared with the control group (81.1% vs 70.5%, P = .27). The proteinuria-free survival was similar at 82.9% and 79.3% for the treatment and control groups, respectively (P = .6); hypertension-free survival was 86.4% and 79.3% (P = .2). After 60 months of follow-up, the estimated glomerular filtration rate (GFR) was 108.1 +/- 29.0 mL/min/1.73 m(2) for the treatment group and 105.7 +/- 17.7 mL/min/1.73 m(2) for the control group (P = .7), but the difference was not statistically significant. None of the patients developed impaired renal function. The rate of GFR decline was similar between the treatment and control groups (-0.39 +/- 2.57 vs -0.59 +/- 1.63 mL/min/1.73 m(2) per year, respectively, P = .7). In general, the study medication was well tolerated. Two patients needed to stop prematurely because of cough and dizziness. CONCLUSION: For early IgA nephropathy patients with minimal proteinuria, normal blood pressure, and normal renal function, treatment with 2.5 mg/daily of ramipril for 5 years does not offer any benefit. (C) 2013 Elsevier Inc. All rights reserved. The American Journal of Medicine (2013) 126, 162-168