Angiotensin II antagonism improves the lipoprotein profile in patients with nephrotic syndrome

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Objective:To study the effects of the angiotensin II receptor antagonist losartan on the lipid profile of patients with nephrotic range proteinuriaDesign:A single-blind, longitudinal study. Patients were followed during four periods each lasting 1 month, in which they received in sequence once-daily placebo, 50 mg losartan, l00mg losartan and placebo, respectively. Measurements were performed at the end of each study periodPatients:Eleven patients with biops y­­­­­­­­proven renal disease, diastolic blood pressure ≥90mmHg, creatinine clearance ≥50ml/min, stable proteinuria ≥2.5g/day, without familial hyperlipidemia or use of hypolipidemic agentsResults:At the end of the 100mg losartan period, median arterial blood pressure had fallen from 114.5±2.3mmHg at baseline to 96±2.8mmHg (P<0.001). Urinary protein excretion decreased from 6.2±1.3g/day to 4.2±1.3g/day (P< 0.001), whereas serum albumin and total protein did not change. Total cholesterol fell significantly from 6.67 ±0.46 mmol/l to 6.08 ± 0.42 mmol/l (P=0.04). This decrease in cholesterol was mainly due to a decrease in very-low-density and low-density lipoprotein cholesterol, though high-density lipoprotein cholesterol also tended to fall. Apolipoprotein B decreased by 13.0±3.6% (P=0.05), whereas the apolipoprotein Ai concentration remained unchanged, thus resulting in a significant increase in the apolipoprotein AT/B ratio (12.5±3.5%, P=0.05). Lipoprotein(a) concentration fell from 287±57mg/l to 218±35mg/l (P=0.07). Interestingly, those patients that had the highest baseline lipoprotein(a) values showed the most outspoken change in lipoprotein(a) levels during treatment. In the placebo recovery period all parameters returned towards baseline valuesConclusions:In addition to lowering blood pressure and proteinuria, the angiotensin II antagonist losartan improves the lipoprotein profile in patients with nephrotic range proteinuria

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