Renoprotective properties of ACE-inhibition in non-diabetic nephropathies with non-nephrotic proteinuria

Piero Ruggenenti, Annalisa Perna, Giulia Gherardi, Giovanni Garini, Carmine Zoccali, Maurizio Salvadori, Francesco Scolari, Francesco Paolo Schena, Giuseppe Remuzzi

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Abstract

Background. Stratum 2 of the Ramipril Efficacy in Nephropathy (REIN) study has already shown that in patients with chronic nephropathies and proteinuria of 3 g or more per 24 h, angiotensin-converting enzyme (ACE) inhibition reduced the rate of decline in glomerular filtration and halved the combined risk of doubling of serum creatinine or end-stage renal failure (ESRF) found in controls on placebo plus conventional antihypertensives. In REIN stratum 1, reported here, 24 h proteinuria was 1 g or more but less than 3 g per 24 h. Methods. In stratum 1 of this double-blind trial 186 patients were randomised to a ramipril or a control (placebo plus conventional antihypertensive therapy) group targeted at achieving a diastolic blood pressure of less than 90 mmHg. The primary endpoints were change in glomerular filtration rate (GFR) and time to ESRF or overt proteinuria (≥ 3 g/24 h). Median follow-up was 31 months. Findings. The decline in GFR per month was not significantly different (ramipril 0.26 [SE 0.05] mL per min per 1.73 m2, control 0.29 [0.06]). Progression to ESRF was significantly less common in the ramipril group (9/99 vs 18/87) for a relative risk (RR) of 2.72 (95% CI 1.22-6.08); so was progression to overt proteinuria (15/99 vs 27/87, RR 2.40 [1.27-4.52]). Patients with a baseline GFR of 45 mL/min/1.73 m2 or less and proteinuria of 1.5 g/24 h or more had more rapid progression and gained the most from ramipril treatment. Proteinuria decreased by 13% in the ramipril group and increased by 15% in the controls. Cardiovascular events were similar. As expected, the rate of decline in GFR and the frequency of ESRF were much lower in stratum 1 than they had been in stratum 2. Interpretation. In non-diabetic nephropathies, ACE inhibition confers renoprotection even to patients with non-nephrotic proteinuria.

Original languageEnglish
Pages (from-to)359-364
Number of pages6
JournalLancet
Volume354
Issue number9176
DOIs
Publication statusPublished - Jul 31 1999

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Ramipril
Peptidyl-Dipeptidase A
Proteinuria
Glomerular Filtration Rate
Chronic Kidney Failure
Antihypertensive Agents
Placebos
Blood Pressure
Group Psychotherapy
Inhibition (Psychology)
Creatinine
Serum

ASJC Scopus subject areas

  • Medicine(all)

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Renoprotective properties of ACE-inhibition in non-diabetic nephropathies with non-nephrotic proteinuria. / Ruggenenti, Piero; Perna, Annalisa; Gherardi, Giulia; Garini, Giovanni; Zoccali, Carmine; Salvadori, Maurizio; Scolari, Francesco; Schena, Francesco Paolo; Remuzzi, Giuseppe.

In: Lancet, Vol. 354, No. 9176, 31.07.1999, p. 359-364.

Research output: Contribution to journalArticle

Ruggenenti, P, Perna, A, Gherardi, G, Garini, G, Zoccali, C, Salvadori, M, Scolari, F, Schena, FP & Remuzzi, G 1999, 'Renoprotective properties of ACE-inhibition in non-diabetic nephropathies with non-nephrotic proteinuria', Lancet, vol. 354, no. 9176, pp. 359-364. https://doi.org/10.1016/S0140-6736(98)10363-X
Ruggenenti, Piero ; Perna, Annalisa ; Gherardi, Giulia ; Garini, Giovanni ; Zoccali, Carmine ; Salvadori, Maurizio ; Scolari, Francesco ; Schena, Francesco Paolo ; Remuzzi, Giuseppe. / Renoprotective properties of ACE-inhibition in non-diabetic nephropathies with non-nephrotic proteinuria. In: Lancet. 1999 ; Vol. 354, No. 9176. pp. 359-364.
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abstract = "Background. Stratum 2 of the Ramipril Efficacy in Nephropathy (REIN) study has already shown that in patients with chronic nephropathies and proteinuria of 3 g or more per 24 h, angiotensin-converting enzyme (ACE) inhibition reduced the rate of decline in glomerular filtration and halved the combined risk of doubling of serum creatinine or end-stage renal failure (ESRF) found in controls on placebo plus conventional antihypertensives. In REIN stratum 1, reported here, 24 h proteinuria was 1 g or more but less than 3 g per 24 h. Methods. In stratum 1 of this double-blind trial 186 patients were randomised to a ramipril or a control (placebo plus conventional antihypertensive therapy) group targeted at achieving a diastolic blood pressure of less than 90 mmHg. The primary endpoints were change in glomerular filtration rate (GFR) and time to ESRF or overt proteinuria (≥ 3 g/24 h). Median follow-up was 31 months. Findings. The decline in GFR per month was not significantly different (ramipril 0.26 [SE 0.05] mL per min per 1.73 m2, control 0.29 [0.06]). Progression to ESRF was significantly less common in the ramipril group (9/99 vs 18/87) for a relative risk (RR) of 2.72 (95{\%} CI 1.22-6.08); so was progression to overt proteinuria (15/99 vs 27/87, RR 2.40 [1.27-4.52]). Patients with a baseline GFR of 45 mL/min/1.73 m2 or less and proteinuria of 1.5 g/24 h or more had more rapid progression and gained the most from ramipril treatment. Proteinuria decreased by 13{\%} in the ramipril group and increased by 15{\%} in the controls. Cardiovascular events were similar. As expected, the rate of decline in GFR and the frequency of ESRF were much lower in stratum 1 than they had been in stratum 2. Interpretation. In non-diabetic nephropathies, ACE inhibition confers renoprotection even to patients with non-nephrotic proteinuria.",
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T1 - Renoprotective properties of ACE-inhibition in non-diabetic nephropathies with non-nephrotic proteinuria

AU - Ruggenenti, Piero

AU - Perna, Annalisa

AU - Gherardi, Giulia

AU - Garini, Giovanni

AU - Zoccali, Carmine

AU - Salvadori, Maurizio

AU - Scolari, Francesco

AU - Schena, Francesco Paolo

AU - Remuzzi, Giuseppe

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N2 - Background. Stratum 2 of the Ramipril Efficacy in Nephropathy (REIN) study has already shown that in patients with chronic nephropathies and proteinuria of 3 g or more per 24 h, angiotensin-converting enzyme (ACE) inhibition reduced the rate of decline in glomerular filtration and halved the combined risk of doubling of serum creatinine or end-stage renal failure (ESRF) found in controls on placebo plus conventional antihypertensives. In REIN stratum 1, reported here, 24 h proteinuria was 1 g or more but less than 3 g per 24 h. Methods. In stratum 1 of this double-blind trial 186 patients were randomised to a ramipril or a control (placebo plus conventional antihypertensive therapy) group targeted at achieving a diastolic blood pressure of less than 90 mmHg. The primary endpoints were change in glomerular filtration rate (GFR) and time to ESRF or overt proteinuria (≥ 3 g/24 h). Median follow-up was 31 months. Findings. The decline in GFR per month was not significantly different (ramipril 0.26 [SE 0.05] mL per min per 1.73 m2, control 0.29 [0.06]). Progression to ESRF was significantly less common in the ramipril group (9/99 vs 18/87) for a relative risk (RR) of 2.72 (95% CI 1.22-6.08); so was progression to overt proteinuria (15/99 vs 27/87, RR 2.40 [1.27-4.52]). Patients with a baseline GFR of 45 mL/min/1.73 m2 or less and proteinuria of 1.5 g/24 h or more had more rapid progression and gained the most from ramipril treatment. Proteinuria decreased by 13% in the ramipril group and increased by 15% in the controls. Cardiovascular events were similar. As expected, the rate of decline in GFR and the frequency of ESRF were much lower in stratum 1 than they had been in stratum 2. Interpretation. In non-diabetic nephropathies, ACE inhibition confers renoprotection even to patients with non-nephrotic proteinuria.

AB - Background. Stratum 2 of the Ramipril Efficacy in Nephropathy (REIN) study has already shown that in patients with chronic nephropathies and proteinuria of 3 g or more per 24 h, angiotensin-converting enzyme (ACE) inhibition reduced the rate of decline in glomerular filtration and halved the combined risk of doubling of serum creatinine or end-stage renal failure (ESRF) found in controls on placebo plus conventional antihypertensives. In REIN stratum 1, reported here, 24 h proteinuria was 1 g or more but less than 3 g per 24 h. Methods. In stratum 1 of this double-blind trial 186 patients were randomised to a ramipril or a control (placebo plus conventional antihypertensive therapy) group targeted at achieving a diastolic blood pressure of less than 90 mmHg. The primary endpoints were change in glomerular filtration rate (GFR) and time to ESRF or overt proteinuria (≥ 3 g/24 h). Median follow-up was 31 months. Findings. The decline in GFR per month was not significantly different (ramipril 0.26 [SE 0.05] mL per min per 1.73 m2, control 0.29 [0.06]). Progression to ESRF was significantly less common in the ramipril group (9/99 vs 18/87) for a relative risk (RR) of 2.72 (95% CI 1.22-6.08); so was progression to overt proteinuria (15/99 vs 27/87, RR 2.40 [1.27-4.52]). Patients with a baseline GFR of 45 mL/min/1.73 m2 or less and proteinuria of 1.5 g/24 h or more had more rapid progression and gained the most from ramipril treatment. Proteinuria decreased by 13% in the ramipril group and increased by 15% in the controls. Cardiovascular events were similar. As expected, the rate of decline in GFR and the frequency of ESRF were much lower in stratum 1 than they had been in stratum 2. Interpretation. In non-diabetic nephropathies, ACE inhibition confers renoprotection even to patients with non-nephrotic proteinuria.

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