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Synergistic effect of mycophenolate mofetil and angiotensin-converting enzyme inhibitor in patients with chronic allograft nephropathy
Moscoso-Solorzano, G. T; Mastroinanni-Kirsztjan, G; Ozaki, K. S; Franco, M. F; Pacheco-Silva, A; Câmara, N. O. S.
  • Moscoso-Solorzano, G. T; Universidade Federal de São Paulo. Hospital do Rim e Hipertensão. Disciplina de Nefrologia. Laboratório de Imunologia Clínica e Experimental. São Paulo. BR
  • Mastroinanni-Kirsztjan, G; Universidade Federal de São Paulo. Hospital do Rim e Hipertensão. Disciplina de Nefrologia. Laboratório de Imunologia Clínica e Experimental. São Paulo. BR
  • Ozaki, K. S; Universidade Federal de São Paulo. Hospital do Rim e Hipertensão. Disciplina de Nefrologia. Laboratório de Imunologia Clínica e Experimental. São Paulo. BR
  • Franco, M. F; Universidade Federal de São Paulo. Departamento de Patologia. São Paulo. BR
  • Pacheco-Silva, A; Universidade Federal de São Paulo. Hospital do Rim e Hipertensão. Disciplina de Nefrologia. Laboratório de Imunologia Clínica e Experimental. São Paulo. BR
  • Câmara, N. O. S; Universidade Federal de São Paulo. Hospital do Rim e Hipertensão. Disciplina de Nefrologia. Laboratório de Imunologia Clínica e Experimental. São Paulo. BR
Braz. j. med. biol. res ; 42(5): 445-452, May 2009. ilus, tab
Article in English | LILACS | ID: lil-511334
ABSTRACT
Experimental data and few clinical non-randomized studies have shown that inhibition of the renin-angiotensin system by angiotensin-converting enzyme (ACE) associated or not with the use of mycophenolate mofetil (MMF) could delay or even halt the progression of chronic allograft nephropathy (CAN). In this retrospective historical study, we investigated whether ACE inhibition (ACEI) associated or not with the use of MMF has the same effect in humans as in experimental studies and what factors are associated with a clinical response. A total of 160 transplant patients with biopsy-proven CAN were enrolled. Eighty-one of them were on ACE therapy (G1) and 80 on ACEI_free therapy (G2). Patients were further stratified for the use of MMF. G1 patients showed a marked decrease in proteinuria and stabilized serum creatinine with time. Five-year graft survival after CAN diagnosis was more frequent in G1 (86.9 vs 67.7 percent; P < 0.05). In patients on ACEI-free therapy, the use of MMF was associated with better graft survival. The use of ACEI therapy protected 79 percent of the patients against graft loss (OR = 0.079, 95 percentCI = 0.015-0.426; P = 0.003). ACEI and MMF or the use of MMF alone after CAN diagnosis conferred protection against graft loss. This finding is well correlated with experimental studies in which ACEI and MMF interrupt the progression of chronic allograft dysfunction and injury. The use of ACEI alone or in combination with MMF significantly reduced proteinuria and stabilized serum creatinine, consequently improving renal allograft survival.
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Full text: Available Index: LILACS (Americas) Main subject: Proteinuria / Angiotensin-Converting Enzyme Inhibitors / Kidney Transplantation / Graft Rejection / Immunosuppressive Agents / Mycophenolic Acid Type of study: Observational study / Risk factors Limits: Adult / Female / Humans / Male Language: English Journal: Braz. j. med. biol. res Journal subject: Biology / Medicine Year: 2009 Type: Article Affiliation country: Brazil Institution/Affiliation country: Universidade Federal de São Paulo/BR

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Full text: Available Index: LILACS (Americas) Main subject: Proteinuria / Angiotensin-Converting Enzyme Inhibitors / Kidney Transplantation / Graft Rejection / Immunosuppressive Agents / Mycophenolic Acid Type of study: Observational study / Risk factors Limits: Adult / Female / Humans / Male Language: English Journal: Braz. j. med. biol. res Journal subject: Biology / Medicine Year: 2009 Type: Article Affiliation country: Brazil Institution/Affiliation country: Universidade Federal de São Paulo/BR