Abstract
This Practice Point commentary discusses the implementation of an intensive, multifactorial intervention in patients who had proteinuria >3 g/day despite treatment with angiotensin-converting-enzyme inhibitors. In their 'Remission Clinic' in Bergamo, Italy, Ruggenenti et al. implemented an individual titration regimen using ramipril 5–10 mg/day, losartan 50–100 mg/day, verapamil 80–120 mg/day and atorvastatin 10–20 mg/day in successive steps, aiming for a low blood pressure target of <120/80 mmHg and a proteinuria target of <0.3 g/day. They found that patients treated in the Remission Clinic had a much slower decline in estimated glomerular filtration rate than a matched historical reference group treated with 1.25–5.00 mg ramipril (diastolic blood pressure goal <90 mmHg). Only 3.6% of Remission Clinic patients reached end-stage renal disease, compared with 30.4% of the historical controls. No information was provided on the individual responses to the different titration steps; therefore, the contributions of the specific components of the regimen towards the therapeutic benefit cannot be established. The data do, however, encourage an individualized and more active approach to preventing end-stage renal disease in individuals with proteinuric chronic kidney disease.
This is a preview of subscription content, access via your institution
Access options
Subscribe to this journal
Receive 12 print issues and online access
$209.00 per year
only $17.42 per issue
Buy this article
- Purchase on Springer Link
- Instant access to full article PDF
Prices may be subject to local taxes which are calculated during checkout
References
Ruggenenti P et al. (2008) Role of remission clinics in the longitudinal treatment of CKD. J Am Soc Nephrol 19: 1213–1224
The GISEN group (1997) Randomised placebo-controlled trial of effect of ramipril on decline in glomerular filtration rate and risk of terminal renal failure in proteinuric, non-diabetic nephropathy. Lancet 349: 1857–1863
de Jong PE et al. (1999) Renoprotective therapy: titration against urinary protein excretion. Lancet 354: 352–353
Vogt L et al. (2008) Effects of dietary sodium and hydrochlorothiazide on the antiproteinuric efficacy of losartan in non-diabetic proteinuric patients. J Am Soc Nephrol 19: 999–1007
Vogt L et al. (2005) Individual titration for maximal blockade of the renin–angiotensin system in proteinuric patients: a feasible strategy? J Am Soc Nephrol 16 (Suppl 1): S53–S57
Ritz E and Wanner C (2008) Lipid abnormalities and cardiovascular risk in renal disease. J Am Soc Nephrol 19: 1065–1070
Author information
Authors and Affiliations
Corresponding author
Ethics declarations
Competing interests
The authors declare no competing financial interests.
Rights and permissions
About this article
Cite this article
de Jong, P., Navis, G. Proteinuria lowering needs a multifactorial and individualized approach to halt progression of renal disease. Nat Rev Nephrol 4, 654–655 (2008). https://doi.org/10.1038/ncpneph0963
Received:
Accepted:
Published:
Issue Date:
DOI: https://doi.org/10.1038/ncpneph0963