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Early RAAS blockade improves short-, long-term renal outcomes in SLE patients with aPLN

23 May 2018
Would your patient really want to know where it came from?

Early renin-angiotensin-aldosterone system (RAAS) blockade with renin-angiotensin system inhibitors (RASI) leads to better short- and long-term renal outcomes in systemic lupus erythematosus (SLE) patients with antiphospholipid-associated nephropathy (aPLN), according to a study, adding that this renal protective effect is independent of RASI’s antihypertensive and antiproteinuric effects.

No significant difference was observed in demographic data, laboratory findings and renal histology by the time of kidney biopsy between the RASI and non-RASI groups. However, the former showed higher proteinuria levels than the latter (5.2; 2.8–8.8 vs 1.9; 0.6–2.8 g/day; p=0.005) and higher prevalence of hypertension (75 percent vs 29 percent; p=0.001).

At 12 months after kidney biopsy, there was no significant between-group difference in estimated glomerular filtration rate (eGFR), mean arterial pressure and proteinuria. The RASI group showed significantly higher improvement ratio of eGFR vs the non-RASI group (26 percent; –5 to 86 percent vs –2 percent; –20 to 20; p=0.028). Beyond 12 months, the rate of change in eGFR was similar between the two groups.

Furthermore, kidney disease progression developed in four patients (23 percent) in the non-RASI group and three (8 percent) in the RASI group during a mean follow-up of 80 months. Early RAAS blockade significantly reduced the risk of kidney disease progression (hazard ratio, 0.11; 0.02–0.59; p=0.010).

The two groups had comparable proteinuria and hypertension controls.

To assess the renal protective effects of RAAS with RASI, the investigators analysed medical data of 57 SLE patients with biopsy-proven aPLN. Early RAAS blockade was defined as administration of RASI within 3 months after kidney biopsy and continued for ≥12 months.

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Most Read Articles
Jairia Dela Cruz, 11 Jan 2019
Use of standard-dose aspirin or other nonsteroidal anti-inflammatory drugs (NSAIDs) appears to confer protection against the risk of endometrial cancer in overweight and obese women, according to a meta-analysis.
Tristan Manalac, 11 Jan 2019
Less than 15 percent of Singaporean adolescents get the recommended 8–10 hours of sleep on a school night, reports a recent study, noting that such short sleep duration is linked to symptoms of depression, overweight or obesity, and poorer self-rated health.
04 Jan 2019
Obstructive sleep apnoea may increase the risk of male-pattern baldness in men with a family history of hair loss, and this association appears to be mediated by low serum transferrin saturation levels related to hypoxia, a study suggests.
6 days ago
Airway type 2 inflammation remains persistent in many asthmatics on inhaled corticosteroids, a new study has shown. These patients tend to be older and have a more severe disease.