Abstract
Progression of renal failure, despite renoprotection with angiotensin-converting enzyme (ACE) inhibitors in patients with proteinuric nephropathies, may be caused by persistent renal production of transforming growth factor-β1 (TGF-β1) through the angiotensin II subtype I 1 (AT1) receptors. We tested the hypothesis that AT1-receptor blocker therapy added to a background of chronic maximal ACE inhibitor therapy will result in a reduction in urinary TGF-β1 levels in such patients. Sixteen patients completed a two-period, crossover, randomized, controlled trial, details of which have been previously reported. All patients were administered lisinopril, 40 mg/d, with either losartan, 50 mg/d, or placebo. Blood pressure (BP) was measured using a 24-hour ambulatory BP monitor. Overnight specimens of urine were analyzed for urine TGF-β1, protein, and creatinine concentrations. Mean age of the study population was 53 ± 9 (SD) years; body mass index, 38 ± 5.7 kg/m2; seated BP, 156 ± 18/88 ± 12 mm Hg; and urine protein excretion, 3.6 ± 0.71 g/g of creatinine. Twelve patients had diabetic nephropathy, and the remainder had chronic glomerulonephritis. At baseline, urinary TGF-β1 levels were significantly increased in the study population compared with healthy controls (13.2 ± 1.2 versus 1.7 ± 1.1 ng/g creatinine; P < 0.001). There was a strong correlation between baseline urine protein excretion and urinary TGF-β1 level (r2 = 0.53; P= 0.001), as well as systolic BP and urinary TGF-β1 level (r2 = 0.57; P < 0.001). After 4 weeks of add-on losartan therapy, there was a 38% (95% confidence interval [CI], 16% to 55%) decline in urinary TG F-β1 levels (13.3 [95% Cl, 11.4 to 15.5] to 8.2 pg/mg creatinine [95% Cl, 6.2 to 10.7]). The reduction in urinary TGF-β1 levels occurred independent of changes in mean urinary protein excretion or BP. Thus, proteinuric patients with renal failure, despite maximal ACE inhibition, had increased urinary levels of TGF-β1 that improved over 1 month of add-on therapy with losartan. We speculate that dual blockade with losartan and an ACE inhibitor may provide additional renoprotection by decreasing renal production of TGF-β1.
| Original language | English (US) |
|---|---|
| Pages (from-to) | 486-492 |
| Number of pages | 7 |
| Journal | American Journal of Kidney Diseases |
| Volume | 39 |
| Issue number | 3 |
| DOIs | |
| State | Published - Jan 1 2002 |
| Externally published | Yes |
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Keywords
- Ambulatory blood pressure (BP)
- Anglotensin-converting enzyme (ACE) inhibitors
- Chronic renal failure (CRF)
- Losartan
- Proteinuria
- Transforming growth factor-β (TGF-β)
ASJC Scopus subject areas
- Nephrology
Cite this
Add-on angiotensin II receptor blockade lowers urinary transforming growth factor-β levels. / Agarwal, Rajiv; Siva, Senthuran; Dunn, Stephen R.; Sharma, Kumar.
In: American Journal of Kidney Diseases, Vol. 39, No. 3, 01.01.2002, p. 486-492.Research output: Contribution to journal › Article
}
TY - JOUR
T1 - Add-on angiotensin II receptor blockade lowers urinary transforming growth factor-β levels
AU - Agarwal, Rajiv
AU - Siva, Senthuran
AU - Dunn, Stephen R.
AU - Sharma, Kumar
PY - 2002/1/1
Y1 - 2002/1/1
N2 - Progression of renal failure, despite renoprotection with angiotensin-converting enzyme (ACE) inhibitors in patients with proteinuric nephropathies, may be caused by persistent renal production of transforming growth factor-β1 (TGF-β1) through the angiotensin II subtype I 1 (AT1) receptors. We tested the hypothesis that AT1-receptor blocker therapy added to a background of chronic maximal ACE inhibitor therapy will result in a reduction in urinary TGF-β1 levels in such patients. Sixteen patients completed a two-period, crossover, randomized, controlled trial, details of which have been previously reported. All patients were administered lisinopril, 40 mg/d, with either losartan, 50 mg/d, or placebo. Blood pressure (BP) was measured using a 24-hour ambulatory BP monitor. Overnight specimens of urine were analyzed for urine TGF-β1, protein, and creatinine concentrations. Mean age of the study population was 53 ± 9 (SD) years; body mass index, 38 ± 5.7 kg/m2; seated BP, 156 ± 18/88 ± 12 mm Hg; and urine protein excretion, 3.6 ± 0.71 g/g of creatinine. Twelve patients had diabetic nephropathy, and the remainder had chronic glomerulonephritis. At baseline, urinary TGF-β1 levels were significantly increased in the study population compared with healthy controls (13.2 ± 1.2 versus 1.7 ± 1.1 ng/g creatinine; P < 0.001). There was a strong correlation between baseline urine protein excretion and urinary TGF-β1 level (r2 = 0.53; P= 0.001), as well as systolic BP and urinary TGF-β1 level (r2 = 0.57; P < 0.001). After 4 weeks of add-on losartan therapy, there was a 38% (95% confidence interval [CI], 16% to 55%) decline in urinary TG F-β1 levels (13.3 [95% Cl, 11.4 to 15.5] to 8.2 pg/mg creatinine [95% Cl, 6.2 to 10.7]). The reduction in urinary TGF-β1 levels occurred independent of changes in mean urinary protein excretion or BP. Thus, proteinuric patients with renal failure, despite maximal ACE inhibition, had increased urinary levels of TGF-β1 that improved over 1 month of add-on therapy with losartan. We speculate that dual blockade with losartan and an ACE inhibitor may provide additional renoprotection by decreasing renal production of TGF-β1.
AB - Progression of renal failure, despite renoprotection with angiotensin-converting enzyme (ACE) inhibitors in patients with proteinuric nephropathies, may be caused by persistent renal production of transforming growth factor-β1 (TGF-β1) through the angiotensin II subtype I 1 (AT1) receptors. We tested the hypothesis that AT1-receptor blocker therapy added to a background of chronic maximal ACE inhibitor therapy will result in a reduction in urinary TGF-β1 levels in such patients. Sixteen patients completed a two-period, crossover, randomized, controlled trial, details of which have been previously reported. All patients were administered lisinopril, 40 mg/d, with either losartan, 50 mg/d, or placebo. Blood pressure (BP) was measured using a 24-hour ambulatory BP monitor. Overnight specimens of urine were analyzed for urine TGF-β1, protein, and creatinine concentrations. Mean age of the study population was 53 ± 9 (SD) years; body mass index, 38 ± 5.7 kg/m2; seated BP, 156 ± 18/88 ± 12 mm Hg; and urine protein excretion, 3.6 ± 0.71 g/g of creatinine. Twelve patients had diabetic nephropathy, and the remainder had chronic glomerulonephritis. At baseline, urinary TGF-β1 levels were significantly increased in the study population compared with healthy controls (13.2 ± 1.2 versus 1.7 ± 1.1 ng/g creatinine; P < 0.001). There was a strong correlation between baseline urine protein excretion and urinary TGF-β1 level (r2 = 0.53; P= 0.001), as well as systolic BP and urinary TGF-β1 level (r2 = 0.57; P < 0.001). After 4 weeks of add-on losartan therapy, there was a 38% (95% confidence interval [CI], 16% to 55%) decline in urinary TG F-β1 levels (13.3 [95% Cl, 11.4 to 15.5] to 8.2 pg/mg creatinine [95% Cl, 6.2 to 10.7]). The reduction in urinary TGF-β1 levels occurred independent of changes in mean urinary protein excretion or BP. Thus, proteinuric patients with renal failure, despite maximal ACE inhibition, had increased urinary levels of TGF-β1 that improved over 1 month of add-on therapy with losartan. We speculate that dual blockade with losartan and an ACE inhibitor may provide additional renoprotection by decreasing renal production of TGF-β1.
KW - Ambulatory blood pressure (BP)
KW - Anglotensin-converting enzyme (ACE) inhibitors
KW - Chronic renal failure (CRF)
KW - Losartan
KW - Proteinuria
KW - Transforming growth factor-β (TGF-β)
UR - http://www.scopus.com/inward/record.url?scp=0036191924&partnerID=8YFLogxK
UR - http://www.scopus.com/inward/citedby.url?scp=0036191924&partnerID=8YFLogxK
U2 - 10.1053/ajkd.2002.31392
DO - 10.1053/ajkd.2002.31392
M3 - Article
VL - 39
SP - 486
EP - 492
JO - American Journal of Kidney Diseases
JF - American Journal of Kidney Diseases
SN - 0272-6386
IS - 3
ER -