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NDT Advance Access originally published online on April 1, 2007
Nephrology Dialysis Transplantation 2007 22(6):1785; doi:10.1093/ndt/gfm117
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© The Author [2007]. Published by Oxford University Press on behalf of ERA-EDTA. All rights reserved. For Permissions, please email: journals.permissions@oxfordjournals.org

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Email: f.locatelli{at}ospedale.lecco.it

Sir,

I would like to thank Dr Wardle for his comments on our Review [1]. Actually ACEIs are generally very well-tolerated drugs and in our experience, very few patients have to abandon this therapy owing its side effects [2]. This is even more true for ARBs.

I agree with Dr Wardle, that a possible explanation of the difference among patients could be related to racial/pharmacogenetic factors. The message we wished to convey was to use inhibitors of renin–angiotensin II system in patients with IgA nephritis and clinically relevant proteinuria, before using steroids or immunosuppressants.

Moreover, considering that the control of blood pressure is of paramount importance, very often the addition of calcium channel blockers is required, in order to reach the blood pressure target values suggested by the Guidelines. We would like to underline the fact that just using inhibitors of rennin–angiotensin II system, without carefully considering the blood pressure values actually reached, is a very frequent wrong therapeutic approach.

We agree with the relevance of thromboxane to the pathophysiology of IgA nephritis and a possible prescription of a small dosage of aspirin, in patients who can tolerate it (unfortunately the number of these patients is much lower than the number of patients who can tolerate inhibitors of renin–angiothensin II system!).

In the case of rapidly progressive IgA nephritis, as we have already emphasized [2–3], we should be more aggressive, using cytotoxic drugs, possibly including mycophenolate mofetil, which seems much more manageable than Melphalan.

Francesco Locatelli, Claudio Pozzi and Simeone Andrulli

Deparment of Nephrology
and Dialysis, A.Manzoni Hospital
Via Dell'Eremo 9/11,
23900 Lecco, Italy

References

  1. Locatelli F, Pozzi C, Andrulli S. IgA nephritis:ACE inhibitors, steroids, both or neither? Nephrol Dial Transplant (2006) 21:3357–3361.[Free Full Text]
  2. Pozzi C, Andrulli S, Del Vecchio L, et al. Corticosteroid effectiveness in IgA nephropathy: long-term results of a randomized, controlled trial. J Am Soc Nephrol (2004) 15:157–63.[Abstract/Free Full Text]
  3. Locatelli F, Del Vecchio L, Pozzi C. IgA glomerulonephritis: beyond angiotensin-converting enzyme inhibitors. Nat Clin Pract Nephrol (2006) 2:24–31. Review.[CrossRef][Web of Science][Medline]

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This Article
Right arrow Extract Freely available
Right arrow FREE Full Text (PDF) Freely available
Right arrow All Versions of this Article:
22/6/1785-a    most recent
gfm117v1
Right arrow Alert me when this article is cited
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Right arrow Email this article to a friend
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Right arrow Similar articles in ISI Web of Science
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Right arrow Download to citation manager
Right arrowRequest Permissions
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Google Scholar
Right arrow Articles by Locatelli, F.
Right arrow Articles by Andrulli, S.
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Right arrow Articles by Locatelli, F.
Right arrow Articles by Andrulli, S.
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