Renin-angiotensin system blockade in biopsy-proven allograft nephropathy

Allograft nephropathy leads to progressive renal injury and ultimate graft loss. In native kidney disease, the use of angiotensin-converting enzyme inhibitors (ACEi) or angiotensin receptor blockers (ARB) is beneficial in retarding the decline of renal function. We reviewed a cohort of renal transpl...

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Bibliographic Details
Published in:Transplantation proceedings 2003-11, Vol.35 (7), p.2415-2417
Main Authors: Zaltzman, J.S, Nash, M, Chiu, R, Prasad, G.V.R
Format: Article
Language:English
Subjects:
Angiotensin Receptor Antagonists
Angiotensin-Converting Enzyme Inhibitors - therapeutic use
Antihypertensive agents
Biological and medical sciences
Biopsy
Cardiovascular system
Chronic Disease
Creatinine - blood
Creatinine - urine
Humans
Kidney Transplantation - pathology
Medical sciences
Pharmacology. Drug treatments
Postoperative Complications - classification
Postoperative Complications - pathology
Renin-Angiotensin System - drug effects
Retrospective Studies
Surgery (general aspects). Transplantations, organ and tissue grafts. Graft diseases
Surgery of the urinary system
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Summary:Allograft nephropathy leads to progressive renal injury and ultimate graft loss. In native kidney disease, the use of angiotensin-converting enzyme inhibitors (ACEi) or angiotensin receptor blockers (ARB) is beneficial in retarding the decline of renal function. We reviewed a cohort of renal transplant recipients who were prescribed either an ACEi or ARB for biopsy-proven allograft nephropathy. Patients were followed from time of initiation of ACEi/ARB and were stratified based on biopsy findings. Outcomes of interest included safety, allograft survival, renal function, and rate of renal function decline pre- and post-ACEi/ARB. The 5-year allograft survival after biopsy was 83%. Mean serum creatinine was 2.2 ± 1.1 mg/dL (range 1.0 to 4.3) at time of biopsy and 2.6 ± 1.2 mg/dL (1.2 to 6.5) at last follow-up. The mean slope of the creatinine versus time (SD) was 2.43 (7.93) in the 12 months prior to therapy and 1.45 (3.66) following therapy, with the absolute difference in slope −3.38 (6.06) ( P = .0004). We conclude that treatment with ACEi/ARB is beneficial in the management of allograft nephropathy.
ISSN:0041-1345
1873-2623
DOI:10.1016/j.transproceed.2003.08.012