Journal Article

The benefits of renin–angiotensin blockade in renal transplant recipients with biopsy-proven allograft nephropathy

Jeffrey S. Zaltzman, Michelle Nash, Rick Chiu and Ramesh Prasad

in Nephrology Dialysis Transplantation

Published on behalf of European Renal Association - European Dialysis and Transplant Assoc

Volume 19, issue 4, pages 940-944
Published in print April 2004 | ISSN: 0931-0509
Published online April 2004 | e-ISSN: 1460-2385 | DOI: http://dx.doi.org/10.1093/ndt/gfg593
The benefits of renin–angiotensin blockade in renal transplant recipients with biopsy-proven allograft nephropathy

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Background. Allograft nephropathy, regardless of aetiology, leads to progressive renal injury and eventual graft loss. In native kidney disease, treatment of hypertension, in particular with angiotensin-converting enzyme inhibitors (ACEi) or angiotensin receptor blockers (ARB), has proven beneficial in retarding renal function decline. In the present study, we reviewed the clinical course of a renal transplant recipient cohort that was prescribed either an ACEi or ARB for biopsy-proven allograft nephropathy.

Methods. Patients were followed from the time of post-biopsy initiation of ACEi/ARB and were stratified based on biopsy findings. Outcomes of interest included safety, allograft survival, renal function and change in slope of renal function pre- and post-ACEi/ARB.

Results. The 5 year allograft survival after biopsy diagnosis of allograft nephropathy was 83%. Serum creatinine was 191±97 (86–377) μmol/l at the time of biopsy and 228±102 (102–575) μmol/l at last follow-up. The slopes of reciprocal creatinine vs time were used to calculate the decline in renal function and were compared pre- and post-ACEi/ARB. The mean slope±SD was –0.06±0.21 l/μmol × 10–3 per month in the 12 months prior to therapy and –0.03±0.09 l/μmol × 10–3 per month following therapy. The absolute difference in slopes was 0.03 (P =<0.0001).

Conclusions. Treatment with ACEi/ARB may be beneficial in the management of allograft nephropathy.

Keywords: allograft nephropathy; angiotensin-converting enzyme inhibitors; angiotensin receptor antagonists

Journal Article.  2835 words.  Illustrated.

Subjects: Nephrology

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