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

Research output: Contribution to journalArticlepeer-review

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

ASJC Scopus subject areas

  • Medicine(all)

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