Nephrol Dial Transplant (2003) 18: 1115-1121
© 2003 European Renal Association-European Dialysis and Transplant Association
Effect of losartan and amlodipine on proteinuria and transforming growth factor-ß1 in patients with IgA nephropathy
Department of Internal Medicine, College of Medicine, Institute of Kidney Disease, Yonsei University, Seoul, Korea
Background. Transforming growth factor-ß1 (TGF-ß1) is the major profibrotic cytokine involved in many renal diseases, and urinary TGF-ß1 reflects intrarenal TGF-ß1 production. Urinary TGF-ß1 excretion is reported to be significantly increased in patients with immunoglobulin A (IgA) nephropathy. The aim of the present study was to compare the effects of losartan and amlodipine on proteinuria, as well as on serum and urine TGF-ß1 levels in IgA nephropathy patients with hypertension and proteinuria.
Methods. The initial 4 week washout period was followed by 12 weeks of active treatment, in which patients were randomized to once-daily treatment with losartan 50 mg (group 1, n=20) or amlodipine 5 mg (group 2, n=16). Urinary protein and TGF-ß1 excretion, serum TGF-ß1 and other clinical parameters were determined at baseline and during 12 weeks of active treatment.
Results. Both treatments controlled blood pressure (BP) to a similar degree, and renal function and other biochemical parameters did not change during the study period. Urinary protein and TGF-ß1 excretions were significantly elevated in IgA nephropathy patients. Losartan significantly reduced urinary protein (from 2.3±1.5 g/day at baseline to 1.2±1.5 g/day at 12 weeks, P<0.05) and urinary TGF-ß1 excretion (from 31.2±14.0 pg/mg creatinine at baseline to 22.1±13.5 pg/mg creatinine at 12 weeks, P<0.05). In contrast, amlodipine had no affect on urinary protein and TGF-ß1 excretion. Both losartan and amlodipine failed to reduce serum TGF-ß1 levels.
Conclusion. Losartan and amlodipine, with similar control of BP, showed different effects on urine protein or TGF-ß1 excretion. Whereas losartan improved both urinary parameters, amlodipine did not. These differences might be important for the management of IgA nephropathy.
Keywords: amlopidine; IgA nephropathy; losartan; proteinuria; transforming growth factor-ß1
Correspondence and offprint requests to: Dae Suk Han, MD, PhD, Department of Internal Medicine, College of Medicine, Institute of Kidney Disease, Yonsei University, Seoul, Korea. E<->mail: dshan{at}yumc.yonsei.ac.kr
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