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Potential role of urinary angiotensinogen in predicting antiproteinuric effects of angiotensin receptor blocker in non-diabetic chronic kidney disease patients: a preliminary report
  1. Hye Ryoun Jang1,
  2. Yu-Ji Lee2,
  3. Sung Rok Kim2,
  4. Sung Gyun Kim3,
  5. Eun Hee Jang4,
  6. Jung Eun Lee1,
  7. Wooseong Huh1,
  8. Yoon-Goo Kim1
  1. 1Nephrology Division, Department of Medicine, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, Korea
  2. 2Nephrology Division, Department of Medicine, Samsung Changwon Hospital, Sungkyunkwan University School of Medicine, Changwon, Korea
  3. 3Department of Internal Medicine and Kidney Research Institute, Hallym University College of Medicine, Anyang, Korea
  4. 4Department of Internal Medicine, Jeju National University College of Medicine, Jeju, Korea
  1. Correspondence to Professor Yoon-Goo Kim, Division of Nephrology, Department of Medicine, Samsung Medical Center, Sungkyunkwan University School of Medicine, 50 Irwon-dong, Gangnam-gu, 135-710, Seoul, Korea; ygkim26{at}skku.edu

Abstract

Objectives Many chronic kidney disease (CKD) patients have persistent overt proteinuria despite angiotensin receptor blocker (ARB) treatment. This study investigated whether the initial difference in intrarenal renin–angiotensin system activity measured with urinary angiotensinogen would affect the antiproteinuric effects of ARB.

Methods Between September 2005 and September 2008, in 50 non-diabetic proteinuric CKD patients not taking renin–angiotensin system inhibitors, the urinary protein/creatinine ratio (P/Cr), angiotensinogen/creatinine ratio (AGT/Cr), plasma renin and aldosterone were measured before starting valsartan, and were followed for 18 months.

Results Patients were divided into three groups according to their initial urinary AGT/Cr. The urinary P/Cr was lower in the low angiotensinogen group, but similar in the high and extremely high angiotensinogen groups (1.3±0.38 vs 2.0±0.92 vs 2.2±0.78). In all groups, the urinary P/Cr was decreased most for the first 6 months. The urinary P/Cr reduction at 6 months was greatest in the high angiotensinogen group (−24.2% vs −46.2% vs −16.4%). The urinary AGT/Cr was decreased most in the high angiotensinogen group. Renal functional deterioration was attenuated in the high angiotensinogen group compared with the extremely high angiotensinogen group.

Conclusions The antiproteinuric effects of ARB were different according to the initial urinary angiotensinogen levels. These results suggest the potential value of the initial urinary AGT/Cr for predicting the therapeutic effect of ARB in proteinuric non-diabetic CKD patients.

  • Angiotensin receptor blocker
  • angiotensinogen
  • antiproteinuric effects
  • chronic renal failure
  • glomerulonephritis

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Footnotes

  • Funding This study was supported by Novartis.

  • Competing interests None.

  • Ethics approval Ethics approval was provided by Samsung Medical Center institutional review board.

  • Provenance and peer review Not commissioned; externally peer reviewed.

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