Comparison of the influence of angiotensin-converting enzyme inhibitor lisinopril and angiotensin II receptor antagonist losartan in patients with idiopathic membranous nephropathy and nephrotic syndrome

Abstract

Objective. 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. Material and methods. 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. Results. 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 × 1.73 m²) 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. Conclusion. 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.

Key Words::

• ACE inhibitors
• angiotensin II receptor antagonists
• lisinopril
• losartan
• idiopathic membranous nephropathy
• nephrotic syndrome

Acknowledgement

The authors wish to thank Alan Bevington PhD, Department of Infection, Immunity and Inflammation, University of Leicester, UK, for his constructive comments on the presentation of this article.

Conflicts of interest

None.