Original article Renin–angiotensin system inhibitors reduce the progression of mesangioproliferative glomerulonephritis: 10 year follow-up ☆ Pierangela Presta a, ⁎, Roberto Minutolo b , Carmela Iodice b , Nicola Comi a , Vincenzo Casoria a , Laura Fuiano a , Chiara Caglioti a , Giuseppe Conte b , Giorgio Fuiano a a Nephrology Unit, Department of Clinical and Experimental Medicine, “Magna Graceia” University of Catanzaro, Italy b Nephrology Unit, Faculty of Medicine, Second University of Naples, Italy abstract article info Article history: Received 18 March 2011 Received in revised form 11 August 2011 Accepted 20 August 2011 Available online 28 September 2011 Keywords: Inhibitors of angiotensin II Mesangioproliferative glomerulonephritis Proteinuria Background: Proteinuria is a common presentation of mesangioproliferative glomerulonephritis (MsPGN). No studies are available on the long-term effect of treatment by renin–angiotensin system (RAS) inhibitors on renal outcome in MsPGN patients. This study prospectively evaluates the effects of RAS inhibitors on renal outcome in patients with low risk MsPGN followed up for 10 years using historical patients with similar fea- tures at the time of presentation as untreated controls. Methods: Endpoints: decrease of basal proteinuria N 20% and loss N 20% of basal glomerular filtrate rate (GFR) at the end of first year of observation. The patients were re-evaluated bimonthly during the first year and every 6 months thereafter. Results: Twenty-five patients fulfilled the selection criteria. After one year follow-up 19 patients reached the endpoint of proteinuria and no patient reached the endpoint of GFR. No significant change in blood pressure levels (BP) and GFR was registered, by contrast daily proteinuria decreased significantly (p b 0.001), falling by 29% at sixth month and 47% at the end of the follow-up. The historical control group consisted of 15 untreated patients seen between 1987 and 1992. The two-way analysis of variance for repeated measures showed greater values of GFR (p b 0.001) and lower levels of daily proteinuria (p b 0.001) in treated patients as com- pared to untreated controls. Conclusions: This 10-year follow-up study indicates that the early treatment with RAS inhibitors at low doses favourably influences the long-term renal outcome in proteinuric patients with MsPGN. Limitations were the small sample size and lack of randomization. © 2011 European Federation of Internal Medicine. Published by Elsevier B.V. All rights reserved. 1. Introduction Asymptomatic urinary abnormalities (AUA), particularly protein- uria, represent a common presentation of renal diseases since simple and rapid dipstick testing became widely available. A frequent diag- nosis in adult patients with AUA, and normal or near normal renal function is mesangioproliferative glomerulonephritis (MsPGN) char- acterised by diffuse or focal increase of glomerular mesangial cells and matrix with or without mesangial deposits of immunoglobulins (IgA or others) and/or complement. Most cases of MsPGN belong to nephropathy with IgA deposits (IgA-MsPGN), but MsPGN with immunodeposits other than IgA and without deposits MsPGN (i.e. without immunodeposits at all) are also frequent diagnoses, accounting for 7 to 25% of the diagnoses of all adult native renal biopsy and 24 to 31% of the histological diagno- ses in patients with AUA [1], depending mainly on the geographic area and the recruitment threshold for a kidney biopsy. Indeed, moderate proteinuria is not only a common presentation for MsPGN but also a relevant predictor of glomerular filtrate rate (GFR) worsening. The Toronto Registry of IgA nephropathy has, in fact, recent- ly calculated that each incremental gram per day above 1 was associat- ed with a 10- to 25-fold more rapid rate of GFR decline [2]. However, data on treatment of proteinuric without deposits MsPGN have not been published to our knowledge. Conversely, the clinical course of proteinuric IgA-MsPGN has been extensively investigated (particularly the responsiveness to treatment with renin–angiotensin system (RAS) inhibitors) [3] but in studies of short- and medium-follow-up. On this regard, data on long-term efficacy of RAS inhibitors are critical since the reappearance of proteinuria after successful pharmacologic blood- pressure control by RAS-inhibitors has been recently reported to occur in a consistent proportion of adults receiving long-term RAS-inhibitors therapy [4,5]. European Journal of Internal Medicine 22 (2011) e90–e94 ☆ The manuscript has been seen and approved by all authors and it is not under con- sideration for publication elsewhere. ⁎ Corresponding author at: Nephrology Unit, “Magna Graecia” University, Campus Germaneto, Viale Europa, 88100 Catanzaro, Italy. Tel.: +39 3204353228; fax: + 39 09613647586. E-mail address: piera.presta@gmail.com (P. Presta). 0953-6205/$ – see front matter © 2011 European Federation of Internal Medicine. Published by Elsevier B.V. All rights reserved. doi:10.1016/j.ejim.2011.08.021 Contents lists available at SciVerse ScienceDirect European Journal of Internal Medicine journal homepage: www.elsevier.com/locate/ejim