lisinopril and Nephrotic-Syndrome

In this prospective study, the effects of an angiotensin-converting enzyme inhibitor [lisinopril (LIS)] and an angiotensin II receptor antagonist [losartan (LOS)] were compared in nephrotic patients with idiopathic membranous nephropathy.. Twenty-seven patients (13 males, mean age +/- SD 51.3 +/- 15.4 years) were treated with LIS (13 patients, six males, mean age 52.1 +/- 15.3 years) or LOS (14 patients, seven males, mean age 50.5 +/- 15.5 years) for 12 months. At baseline and after the treatment period, serum albumin, total cholesterol, estimated glomerular filtration rate (GFR), 24 h proteinuria and mean arterial pressure were determined.. Proteinuria (g/24 h) was significantly reduced in both groups (LIS from 4.82 +/- 1.26 to 1.75 +/- 0.64, p < 0.0001; LOS from 4.55 +/- 1.09 to 2.54 +/- 1.94, p = 0.002) (all results +/- SD). Serum albumin levels (g/dl) increased significantly in both groups (LIS 2.27 +/- 0.41 to 3.17 +/- 0.63, p < 0.0001; LOS 2.93 +/- 0.40 to 3.55 +/- 0.44, p < 0.0001). GFR (ml/min x 1.73 m(2)) did not change significantly in either group (LIS 55 +/- 17 to 56 +/- 17, p = 0.65; LOS 64 +/- 18 to 59 +/- 16, p = 0.13). Total cholesterol (mg/dl) was significantly reduced only in the lisinopril group (LIS 347 +/- 81 to 266 +/- 64, p < 0.0001; LOS 306 +/- 58 to 263 +/- 77, p = 0.138). Mean arterial pressure (mmHg) was reduced in both groups (LIS 107 +/- 12 to 95 +/- 6, p < 0.0001; LOS 104 +/- 10 to 96 +/- 5, p = 0.003). In the comparison between the two groups, serum albumin levels were higher in the losartan group at baseline (p < 0.0001) and after 12 months (p = 0.029). There were no significant differences between the baseline and end-of-study values for the rest of the studied parameters.. Treatment with lisinopril and losartan in nephrotic patients with idiopathic membranous nephropathy results in similar (and significant) effects on renal function, hypoalbuminaemia, proteinuria and blood pressure.

Topics: Adult; Aged; Albuminuria; Angiotensin II Type 1 Receptor Blockers; Angiotensin-Converting Enzyme Inhibitors; Blood Pressure; Female; Glomerular Filtration Rate; Glomerulonephritis, Membranous; Humans; Hypercholesterolemia; Lisinopril; Losartan; Male; Middle Aged; Nephrotic Syndrome; Prevalence; Prospective Studies; Proteinuria

In this prospective randomized trial, we compared the effects of cyclosporine- and cyclophosphamide-based treatment regimens in patients with idiopathic membranous nephropathy. Twenty-eight patients were randomized to receive treatment with one of the three therapeutic regimens: cyclosporine with methylprednisolone, cyclophosphamide with methylprednisolone or lisinopril (control). Renal function and nephrotic syndrome parameters were determined at baseline and during a 9-month treatment period. At the end of the study period, renal function improved significantly in the cyclophosphamide and deteriorated significantly in the cyclosporine group. Serum albumin levels increased significantly in the cyclosporine and cyclophosphamide group. Total cholesterol levels and proteinuria were significantly reduced in all groups. In the comparison between the groups, serum albumin levels were significantly lower in the control group and there were no differences in the rest of the studied parameters at the end of the study. Six patients from the cyclosporine group (1/10 complete and 5/10 partial), all cyclophosphamide-treated (4/8 complete and 4/8 partial) and all 10 lisinopril-treated patients (10/10 partial) were on remission at the end of the study. In conclusion, cyclosporine-based regimens are not inferior to cyclophosphamide-based regimens. Cyclophosphamide is associated with more complete remissions after 9 months of treatment. Lisinopril is associated with a significant proteinuria reduction and without inducing any complete remissions.

Topics: Cyclophosphamide; Cyclosporine; Female; Glomerulonephritis, Membranous; Humans; Immunosuppressive Agents; Lisinopril; Male; Middle Aged; Nephrotic Syndrome; Prospective Studies

Administration of prednisolone causes an abrupt rise in proteinuria in patients with a nephrotic syndrome.. To clarify the mechanisms responsible for this increase in proteinuria we have performed a placebo controlled study in 26 patients with a nephrotic syndrome. Systemic and renal haemodynamics and urinary protein excretion were measured after prednisolone and after placebo.. After i.v. administration of 125-150 mg prednisolone total proteinuria increased from 6.66+/-4.42 to 9.37+/-6.07 mg/min (P<0.001). By analysing the excretion of proteins with different charge and weight (albumin, transferrin, IgG, IgG4 and beta2-microglobulin) it became apparent that the increase of proteinuria was the result of a change in size selectivity rather than a change in glomerular charge selectivity or tubular protein reabsorption. Glomerular filtration rate rose from 83+/-34 ml to 95+/-43 ml/min (P<0.001) after 5 h, whereas effective renal plasma flow and endogenous creatinine clearance remained unchanged. As a result filtration fraction was increased, compatible with an increased glomerular pressure, which probably contributes to the size selectivity changes. Since corticosteroids affect both the renin-angiotensin system and renal prostaglandins, we have evaluated the effects of prednisolone on proteinuria after pretreatment with 3 months of the angiotensin-converting enzyme inhibitor lisinopril or after 2 weeks of the prostaglandin synthesis inhibitor indomethacin. Neither drug had any effect on prednisolone-induced increases of proteinuria.. Prednisolone increases proteinuria by changing the size selective barrier of the glomerular capillary. Neither the renin-angiotensin axis nor prostaglandins seem to be involved in these effects of prednisolone on proteinuria.

Topics: Adolescent; Adult; Aged; Albuminuria; Angiotensin-Converting Enzyme Inhibitors; beta 2-Microglobulin; Blood Pressure; Cyclooxygenase Inhibitors; Female; Glomerular Filtration Rate; Heart Rate; Hemodynamics; Humans; Immunoglobulin G; Indomethacin; Injections, Intravenous; Lisinopril; Male; Middle Aged; Nephrotic Syndrome; Placebos; Prednisolone; Proteinuria; Renal Circulation; Transferrin

Both angiotensin-converting enzyme (ACE) inhibitors like lisinopril and nonsteroidal anti-inflammatory drugs (NSAIDs) like indomethacin have been shown to lower urinary protein excretion in renal disease. If this effect is caused by different mechanisms of action, the combination of these agents could have an additive antiproteinuric effect. We studied the effects of lisinopril and indomethacin separately and in combination in 10 patients with the nephrotic syndrome. Proteinuria was lowered from 10.5 +/- 1.8 g/24 h in the control period to 4.5 +/- 1.1 g/24 h on indomethacin, 4.3 +/- 1.0 g/24 h on lisinopril and to 2.4 +/- 0.8 g/24 h on the combination. Glomerular filtration rate (GFR) fell on either monotherapy, but particularly on the combination of drugs. The renal hemodynamic changes suggested a preglomerular vasoconstriction by indomethacin and a postglomerular vasodilation by lisinopril. Severe hyperkalemia occurred in 3 patients on the combination therapy. We conclude that the combination of indomethacin and lisinopril has an additive antiproteinuric effect. This, as well as the more pronounced fall in GFR on the combination, may suggest that both drugs lower proteinuria by decreasing intraglomerular capillary pressure but via different mechanisms. Combining these drugs may be useful in the symptomatic treatment of nephrotic syndrome, but renal function and serum potassium should be monitored carefully.

Topics: Adult; Aged; Angiotensin-Converting Enzyme Inhibitors; Anti-Inflammatory Agents, Non-Steroidal; Drug Therapy, Combination; Enalapril; Female; Glomerular Filtration Rate; Humans; Hyperkalemia; Indomethacin; Lisinopril; Male; Middle Aged; Nephrotic Syndrome

Collapsing glomerulopathy is a form of focal segmental glomerulosclerosis that is usually associated with HIV-1 infection, and is characterized by its poor prognosis and almost inevitable progression to end-stage renal disease. Its pathological features include collapsed glomeruli, podocyte hypertrophy and hyperplasia, and pseudocrescents. This case report shows the evolution of a 58-year-old patient with non-HIV idiopathic collapsing glomerulopathy who presented with severe nephrotic syndrome and renal insufficiency and was treated with lisinopril and deflazacort, a synthetic corticosteroid that has shown fewer cosmetic effects and glucose and bone metabolism complications than prednisone. The patient responded with full recovery of renal function and normal range of protein excreted in urine after less than two years of treatment. The patient has not suffered a recurrence of his nephrotic syndrome after three years of steroid withdrawal. There is no proven therapy for collapsing glomerulopathy, and this case highlights an alternative for treating this disease with few secondary effects.

Topics: Angiotensin-Converting Enzyme Inhibitors; Anti-Inflammatory Agents; Biopsy; Drug Therapy, Combination; Glomerulonephritis; Humans; Kidney; Lisinopril; Male; Middle Aged; Nephrotic Syndrome; Pregnenediones; Renal Insufficiency; Severity of Illness Index; Treatment Outcome

Clinical charts of 23 Nigerian children diagnosed with idiopathic steroid resistant nephrotic syndrome (iSRNS) between January 2001 and December 2007 were retrospectively reviewed to determine their clinicopathologic characteristics and outcome. iSRNS (54.8%) was primary in 19 patients (83%) and secondary in four (17%). The mean age at diagnosis was 8.3 ± 3.5 years (2.1-13 years). Histopathology revealed membranoproliferative glomerulonephritis (MPGN) in 43.5%, focal and segmental glomerulosclerosis (FSGS) in 39.1% and mesangial proliferative glomerulonephritis in 8.7% of the patients while minimal change disease (MCD) and membranous nephropathy accounted for 4.35% each. Routine treatment protocol comprised pulse intravenous (i.v.) cylophosphamide infusion and i.v. dexamethasone lisinopril or spironolactone. Cumulative Complete Remission (CR) rate was 57.12%. The overall median time to CR from start of steroid sparing agents in 12/21 treated patients was 4.5 weeks. CR was better achieved in MPGN than FSGS (P = 0.0186). Five patients had eight relapses with the overall median relapse-free duration being four months. Cumulative renal survival at 36 months was 41.8%. The median follow-up duration was eight months. Our study revealed that there was a high prevalence of iSRNS and preponderance of non-MCD lesions, with MPGN and FSGS being the major morphologic lesions. The outcome with steroid and cyclophosphamide-based treatment for iSRNS was further enhanced with addition of either lisinopril or spironolactone.

Topics: Adolescent; Angiotensin-Converting Enzyme Inhibitors; Child; Child, Preschool; Cyclophosphamide; Dexamethasone; Disease-Free Survival; Drug Resistance; Drug Therapy, Combination; Female; Humans; Immunosuppressive Agents; Kaplan-Meier Estimate; Lisinopril; Male; Mineralocorticoid Receptor Antagonists; Nephrotic Syndrome; Nigeria; Prevalence; Pulse Therapy, Drug; Recurrence; Regression Analysis; Retrospective Studies; Spironolactone; Steroids; Time Factors; Treatment Failure

Traditional medicine has being advocated as an alternative to Orthodox medicine in Nigeria despite, its reported adverse effects.. To report an unusual complication of traditional therapy.. A 20-year-old house-wife who was bitten by a crawling insect presented to a hospital with complaints of swollen body and pain in three digits. After clinical evaluation and investigations, she had both medical and surgical intervention.. Two weeks following an insect bite, the patient noticed periorbital and bilateral leg swellings. She sought help from a traditional medicine practitioner who incised and tied the affected digits for three days. He repeated the cycle thrice. She had generalized oedema, massive proteinuria, hypoalbuminaemia, hypercholesterolaemia features consistent with a diagnosis of nephritic syndrome. There was gangrene of the left middle finger and both index toes. Oedema responded to diuretics, lisinopril and low salt diet. She had surgery for the gangrenous digits.. Development of gangrene is an unusual finding in nephrotic syndrome. It occurred in this case as an aftermath of traditional medical intervention. This report reiterates the danger of this form of medical practice and the need for measures to protect the populace to be put in place.

Topics: Adult; Amputation, Surgical; Diuretics; Female; Fingers; Gangrene; Humans; Insect Bites and Stings; Lisinopril; Medicine, African Traditional; Nephrotic Syndrome; Nigeria; Toes; Tourniquets

Topics: Adolescent; Angiotensin II Type 1 Receptor Blockers; Angiotensin-Converting Enzyme Inhibitors; Autoantigens; Basement Membrane; Benzimidazoles; Biopsy; Biphenyl Compounds; Collagen Type IV; Diagnosis, Differential; Drug Therapy, Combination; Glomerulonephritis; Hearing Loss, Sensorineural; Hematuria; Humans; Hydroxymethylglutaryl-CoA Reductase Inhibitors; Hypercholesterolemia; Immunosuppressive Agents; Kidney Glomerulus; Lisinopril; Male; Microscopy, Fluorescence; Nephritis, Hereditary; Nephrotic Syndrome; Prednisone; Proteinuria; Tetrazoles

A 32-year-old male patient was admitted at our department presenting microhematuria and full nephrotic syndrome in April 1995. A percutaneous kidney biopsy showed a stage I-lI membranous nephropathy and an eight-week course with oral prednisone was initiated without response. Then, oral cyclosporine A (3.5 mg/kg/day) was given and after 5 weeks of treatment, remission of the nephrotic syndrome was observed but creatinine raised to 1.6 mg/dl, normalizing after reducing the dose of cyclosporine A. We discuss the settings, prognostic and therapeutic alternatives for idiopathic membranous nephropathy.

Topics: Adult; Angiotensin-Converting Enzyme Inhibitors; Antihypertensive Agents; Calcineurin Inhibitors; Calcium Channel Blockers; Creatinine; Cyclosporine; Drug Therapy, Combination; Glomerulonephritis, Membranous; Humans; Hypercholesterolemia; Hypertension; Hypolipidemic Agents; Immunosuppressive Agents; Kidney Diseases; Lisinopril; Lovastatin; Male; Nephrotic Syndrome; Prednisone; Recurrence; Verapamil

Topics: Adolescent; Angiotensin-Converting Enzyme Inhibitors; Child; Child, Preschool; Drug Resistance; Female; Humans; Lisinopril; Male; Nephrotic Syndrome; Nigeria; Proteinuria; Retrospective Studies; Steroids

Topics: Adolescent; Adult; Angiotensin-Converting Enzyme Inhibitors; Female; Heart Defects, Congenital; Hemodynamics; Humans; Lisinopril; Nephrotic Syndrome

Topics: Aged; Amlodipine; Anti-Infective Agents; Antihypertensive Agents; Clonidine; Creatinine; Diuretics; Female; Furosemide; Humans; Indomethacin; Isosorbide Dinitrate; Lisinopril; Nephrotic Syndrome; Norfloxacin; Proteinuria; Urinary Tract Infections

Topics: Angiotensin-Converting Enzyme Inhibitors; Enalapril; Humans; Lisinopril; Nephrotic Syndrome