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Reviews on Recent Clinical Trials

Editor-in-Chief

ISSN (Print): 1574-8871
ISSN (Online): 1876-1038

Case Report

Successful Use of Aliskiren in a Case of IgA- Mesangial Glomerulonephritis Unresponsive to Conventional Therapies

Author(s): Mariadelina Simeoni*, Ramona Nicotera, Elena Pelagi, Emanuela Libri, Nicolino Comi and Giorgio Fuiano

Volume 14, Issue 1, 2019

Page: [72 - 76] Pages: 5

DOI: 10.2174/1574887113666180726103648

Price: $65

Abstract

Introduction: The early suspension of Altitude trial in recent years has induced most nephrologists and cardiologists to abandon Aliskiren use. Consequently, the potential usefulness of the direct renin inhibition in IgA glomerulonephritis remained an under-investigated therapeutic option.

Case Report: We report the case of a 53 years old IgA GMN patient unresponsive to all conventional anti-angiotensin-2 agents, steroids and immunosuppressants, in which the administration of Aliskiren permitted to achieve and maintain a complete proteinuria remission in the absence of any adverse event.

Conclusion: Aliskiren might represent a valid and safe therapeutic option in IgA GMN, although further investigations would be needed to confirm this conclusion.

Keywords: Aliskiren, IgA GMN, proteinuria, conventional therapies, case report, Chronic Kidney Disease (CKD).

Graphical Abstract

[1]
Hill NR, Fatoba ST, Oke JL, et al. Global prevalence of chronic kidney disease - A Systematic review and meta-analysis. PLoS One 2016; 11(7): e0158765.
[2]
Simeoni M, Cianfrone P, Comi N, et al. Is it feasible to improve the duration and the efficiency of Ramipril anti-proteinuric response?. G Ital Nefrol 2015; 32(1), pii: gin/32.
[3]
D’Onofrio G, Simeoni M, Rizza P, et al. Quality of life, clinical outcome, personality and coping in chronic hemodialysis patients. Ren Fail 2017; 39(1): 45-53.
[4]
Tomino Y. Diagnosis and treatment of patients with IgA nephropathy in Japan. Kidney Res Clin Pract 2016; 35(4): 197-203.
[5]
Cheng J, Zhang X, Zhang W, et al. Efficacy and safety of glucocorticoids therapy for IgA nephropathy: A meta-analysis of randomized controlled trials. Am J Nephrol 2009; 30(4): 315-22.
[6]
Pozzi C. Pro: STOP immunosuppression in IgA nephropathy? Nephrology, dialysis, transplantation : Official publication of the European Dialysis and Transplant Association - European Renal Association 2016; 31(11): 1766-70.
[7]
Coppo R, Peruzzi L, Amore A, et al. IgACE: A placebo-controlled, randomized trial of angiotensin-converting enzyme inhibitors in children and young people with IgA nephropathy and moderate proteinuria. J Am Soc Nephrol JASN 2007; 18(6): 1880-8.
[8]
Cianfrone P, Simeoni M, Comi N, et al. How to improve duration and efficiency of the antiproteinuric response to Ramipril: RamiPROT-a prospective cohort study. J Nephrol 2017; 30(1): 95-102.
[9]
Nguyen G, Delarue F, Burckle C, et al. Pivotal role of the renin/prorenin receptor in angiotensin II production and cellular responses to renin. J Clin Invest 2002; 109(11): 1417-27.
[10]
Prieto-Carrasquero MC, Kobori H, et al. AT1 receptor-mediated enhancement of collecting duct renin in angiotensin II-dependent hypertensive rats. Am J Physiol Renal Physiol 2005; 289(3): F632-7.
[11]
Danser AH, Derkx FH, Schalekamp MA, et al. Determinants of interindividual variation of renin and prorenin concentrations: Evidence for a sexual dimorphism of (pro)renin levels in humans. J Hypertens 1998; 16(6): 853-62.
[12]
Huang Y, Noble NA, Zhang J, Xu C, Border WA. Renin-stimulated TGF-beta1 expression is regulated by a mitogen-activated protein kinase in mesangial cells. Kidney Int 2007; 72(1): 45-52.
[13]
Advani A, Kelly DJ, Cox AJ, et al. The (Pro)renin receptor: Site-specific and functional linkage to the vacuolar H+-ATPase in the kidney. Hypertension 2009; 54(2): 261-9.
[14]
Nguyen G, Delarue F, Berrou J, Rondeau E, Sraer JD. Specific receptor binding of renin on human mesangial cells in culture increases plasminogen activator inhibitor-1 antigen. Kidney Int 1996; 50(6): 1897-903.
[15]
Huang Y, Border WA, Noble NA. Functional renin receptors in renal mesangial cells. Curr Hypertens Rep 2007; 9(2): 133-9.
[16]
Huang Y, Wongamorntham S, Kasting J, et al. Renin increases mesangial cell transforming growth factor-beta1 and matrix proteins through receptor-mediated, angiotensin II-independent mechanisms. Kidney Int 2006; 69(1): 105-13.
[17]
Kaneshiro Y, Ichihara A, Sakoda M, et al. Slowly progressive, angiotensin II-independent glomerulosclerosis in human (pro)renin receptor-transgenic rats. J Am Soc Nephrol: JASN 2007; 18(6): 1789-95.
[18]
Sanoski CA. Aliskiren: An oral direct renin inhibitor for the treatment of hypertension. Pharmacotherapy 2009; 29(2): 193-212.
[19]
Riccioni G. Aliskiren in the treatment of hypertension and organ damage. Cardiovas Therapeut 2011; 29(1): 77-87.
[20]
Feldman DL, Jin L, Xuan H, et al. Effects of aliskiren on blood pressure, albuminuria, and (pro)renin receptor expression in diabetic TG(mRen-2)27 rats. Hypertension 2008; 52(1): 130-6.
[21]
Simeoni M, Nicotera R, Colao M, et al. Direct inhibition of plasmatic renin activity with aliskiren: A promising but under-investigated therapeutic option for non-diabetic glomerulonephritis. Int Urol Nephrol 2016; 48(2): 229-37.
[22]
Ferri N, Greco CM, Maiocchi G, Corsini A. Aliskiren reduces prorenin receptor expression and activity in cultured human aortic smooth muscle cells. J Renin Angiotensin Aldosterone Syst: JRAAS 2011; 12(4): 469-74.
[23]
McMurray JJ, Abraham WT, Dickstein K, et al. Aliskiren, ALTITUDE, and the implications for ATMOSPHERE. Eur J Heart Fail 2012; 14(4): 341-3.
[24]
Zheng SL, Roddick AJ, Ayis S. Effects of aliskiren on mortality, cardiovascular outcomes and adverse events in patients with diabetes and cardiovascular disease or risk: A systematic review and meta-analysis of 13,395 patients. Diab Vasc Dis Res 2017; 14(5): 400-6.
[25]
Kelly DJ, Zhang Y, Moe G, Naik G, Gilbert RE. Aliskiren, a novel renin inhibitor, is renoprotective in a model of advanced diabetic nephropathy in rats. Diabetologia 2007; 50(11): 2398-404.
[26]
Lizakowski S, Tylicki L, Rutkowski B. Direct renin inhibition--a promising strategy for renal protection? Med Sci Monit 2013; 19: 451-7.
[27]
Gross O, Girgert R, Rubel D, et al. Renal protective effects of aliskiren beyond its antihypertensive property in a mouse model of progressive fibrosis. Am J Hypertens 2011; 24(3): 355-61.
[28]
Tang SC, Lin M, Tam S, et al. Aliskiren combined with losartan in immunoglobulin A nephropathy: An open-labeled pilot study. Nephrol Dial Transplant 2012; 27(2): 613-8.
[29]
Wu MT, Tung SC, Hsu KT, Lee CT. Aliskiren add-on therapy effectively reduces proteinuria in chronic kidney disease: an open-label prospective trial. J Renin Angiotensin Aldosterone Syst: JRAAS 2014; 15(3): 271-7.
[30]
Moriyama T, Tsuruta Y, Kojima C, et al. Beneficial effect of aliskiren combined with olmesartan in reducing urinary protein excretion in patients with chronic kidney disease. Int Urol Nephrol 2012; 44(3): 841-5.
[31]
Li PK, Leung CB, Chow KM, et al. Hong Kong study using valsartan in IgA nephropathy (HKVIN): A double-blind, randomized, placebo-controlled study. Am J Kidney Dis 2006; 47(5): 751-60.
[32]
Woo KT, Choong HL, Wong KS, et al. Aliskiren and losartan trial in non-diabetic chronic kidney disease. J Renin Angiotensin Aldosterone Sys: JRAAS 2014; 15(4): 515-22.
[33]
Szeto CC, Kwan BC, Chow KM, Leung CB, Li PK. The safety and short-term efficacy of aliskiren in the treatment of immunoglobulin a nephropathy--a randomized cross-over study. PLoS One 2013; 8(5): e62736.
[34]
Trimarchi H, Barratt J, Cattran DC, et al. Oxford Classification of IgA nephropathy 2016: An update from the IgA Nephropathy Classification Working Group. Kidney Int 2017; 91(5): 1014-21.
[35]
Pozzi C, Bolasco PG, Fogazzi GB, et al. Corticosteroids in IgA nephropathy: A randomised controlled trial. Lancet 1999; 353(9156): 883-7.
[36]
Mann JF, Schmieder RE, McQueen M, et al. Renal outcomes with telmisartan, ramipril, or both, in people at high vascular risk (the ONTARGET study): A multicentre, randomised, double-blind, controlled trial. Lancet 2008; 372(9638): 547-53.
[37]
Clase CM, Barzilay J, Gao P, et al. Acute change in glomerular filtration rate with inhibition of the renin-angiotensin system does not predict subsequent renal and cardiovascular outcomes. Kidney Int 2017; 91(3): 683-90.
[38]
Ahmed A, Jorna T, Bhandari S. Should We STOP Angiotensin Converting Enzyme Inhibitors/Angiotensin Receptor Blockers in Advanced Kidney Disease? Nephron 2016; 133(3): 147-58.
[39]
Chobanian AV, Bakris GL, Black HR, et al. The seventh report of the joint national committee on prevention, detection, evaluation, and treatment of high blood pressure: The JNC 7 report. JAMA 2003; 289(19): 2560-72.
[40]
Tobe SW, Clase CM, Gao P, et al. Cardiovascular and renal outcomes with telmisartan, ramipril, or both in people at high renal risk: results from the ONTARGET and TRANSCEND studies. Circulation 2011; 123(10): 1098-107.
[41]
Persson F, Rossing P, Reinhard H, et al. Renal effects of aliskiren compared with and in combination with irbesartan in patients with type 2 diabetes, hypertension, and albuminuria. Diabetes Care 2009; 32(10): 1873-9.

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