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Title: High dose Losartan and ACE gene polymorphism in IgA nephritis
Authors: Woo, K.-T.
Chan, C.-M.
Choong, H.-L.
Tan, H.-K.
Foo, M.
Lee, E.J.C.
Tan, C.-C. 
Lee, G.S.L.
Tan, S.-H.
Vathsala, A.
Lim, C.-H.
Chiang, G.S.C.
Fook-Chong, S.
Yi, Z.
Tan, H.B.
Wong, K.-S.
Keywords: ACE Gene polymorphism
Angiotensin receptor blockers
Glomerular filtration rate
Renal failure
Issue Date: Dec-2008
Citation: Woo, K.-T.,Chan, C.-M.,Choong, H.-L.,Tan, H.-K.,Foo, M.,Lee, E.J.C.,Tan, C.-C.,Lee, G.S.L.,Tan, S.-H.,Vathsala, A.,Lim, C.-H.,Chiang, G.S.C.,Fook-Chong, S.,Yi, Z.,Tan, H.B.,Wong, K.-S. (2008-12). High dose Losartan and ACE gene polymorphism in IgA nephritis. Genomic Medicine 2 (3-4) : 83-91. ScholarBank@NUS Repository.
Abstract: Background/aims Several studies have reported varying results of the influence of ACE gene on ACEI/ARB therapy. The efficacy of high dose ARB and its influence on ACE gene have not been explored. This is a 6 year randomised trial in IgA nephritis comparing high dose ARB (Losartan 200 mg/day) with normal dose ARB (Losartan 100 mg/day), normal dose ACEI (20 mg/day) and low dose ACEI (10 mg/day). Results Patients on high dose ARB had significantly lower proteinuria, 1.0 ± 0.8 gm/day compared to 1.7 ± 1.0 g/day in the other groups (P = 0.0005). The loss in eGFR was 0.7 ml min-1year-1 for high dose ARB compared to 3.2-3.5 ml min-1year-1 for the other three groups (P = 0.0005). There were more patients on high dose ARB with improvement in eGFR compared to other three groups (P < 0.001). Comparing patients with the three ACE genotypes DD, ID and II, all three groups responded well to therapy with decrease in proteinuria (P < 0.002). Only those on low dose ACEI (10 mg/day) with the I allele had increased in ESRF (P = 0.037). Conclusion High dose ARB is more efficacious in reducing proteinuria and preserving renal function when compared with normal dose ARB and ACEI, and also obviates the genomic influence of ACE gene polymorphism on renal survival. © 2009 Springer Science+Business Media B.V.
Source Title: Genomic Medicine
ISSN: 18717934
DOI: 10.1007/s11568-009-9030-8
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