Antiproteinuric response to dual blockade of the renin-angiotensin system in primary glomerulonephritis.

This Practice Point commentary discusses a recent meta-analysis by Catapano et al. of 13 randomized controlled trials (n = 425) that investigated the antiproteinuric response to dual blockade of the renin-angiotensin system in patients with proteinuric primary glomerulonephritis. Combination therapy was associated with a significantly greater decrease in proteinuria than either angiotensin-converting-enzyme inhibitor or angiotensin II type I receptor antagonist monotherapy. Dual blockade did not affect glomerular filtration rate, but was associated with a moderate increase in potassium levels. The renin angiotensin system plays a major role in proteinuria, and, therefore, one might expect that more-complete inhibition of the system would offer therapeutic advantages. There are still uncertainties regarding the safety of combination therapy, however, particularly in elderly patients and those with advanced kidney disease. More studies are needed before dual blockade can be widely recommended for all patients with chronic glomerulonephritis, and close monitoring is necessary for those currently receiving this therapy.