Kidney Res Clin Pract.  2018 Sep;37(3):257-265. 10.23876/j.krcp.2018.37.3.257.

Efficacy of low-dose spironolactone on top of angiotensin receptor blockade in patients with glomerulonephritis

• Yu BC
• Lee MS
• Moon JJ
• Choi SJ
• Kim JK
• Hwang SD
• Park MY

• KMID: 2447165
• DOI: http://doi.org/10.23876/j.krcp.2018.37.3.257

Abstract

BACKGROUND
Previous studies have shown that aldosterone antagonists have a proteinuria-lowering effect in patients with proteinuria and progressive proteinuric disease not adequately controlled by the use of angiotensin receptor blockers (ARBs). Aldosterone antagonists, in combination with ARBs, might improve proteinuria in patients with glomerulonephritis (GN).
METHODS
In the present retrospective study, we evaluated the proteinuria-lowering effect and drug safety of low-dose spironolactone (12.5 mg/day) in 42 patients with GN being treated with an ARB.
RESULTS
Proteinuria decreased from a mean total-protein-to-creatinine (TP/Cr) ratio of 592.3 ± 42.0 mg/g at baseline to 335.6 ± 43.3 mg/g after three months of treatment with spironolactone (P < 0.001). After the initial three months, the mean TP/Cr ratio increased progressively at six, nine, and 12 months; however, it was still less than the baseline value (P = 0.001, < 0.001, and < 0.001, respectively). Although serum Cr levels increased significantly at three and nine months compared with baseline (P = 0.036 and 0.026, respectively), there was no time effect of treatment (P = 0.071). Serum potassium levels tended to increase with time (P = 0.118), whereas systolic and diastolic blood pressures decreased with time (P = 0.122 and 0.044, respectively).
CONCLUSION
Low-dose spironolactone in combination with an ARB reduced proteinuria in patients with GN, which could represent a novel treatment option in individuals whose proteinuria is not optimally controlled by the use of ARBs alone.

Keyword

Angiotensin receptor antagonists; Glomerulonephritis; Mineralocorticoid receptor antagonists; Proteinuria; Spironolactone

MeSH Terms

Angiotensin Receptor Antagonists
Angiotensins*
Glomerulonephritis*
Humans
Mineralocorticoid Receptor Antagonists
Potassium
Proteinuria
Retrospective Studies
Spironolactone*
Angiotensin Receptor Antagonists
Angiotensins
Mineralocorticoid Receptor Antagonists
Potassium
Spironolactone