Comparison between the angiotensin II receptor antogonist losartan and the angiotensin-converting enzyme inhibitor enalapril in proteinuria of patients with nephrotic syndrome

Comparison between the angiotensin II receptor antagonist losartan and the angiotensin-converting enzyme inhibitor Enalapril in proteinuria of patients with nephrotic syndrome As proteinuria plays a major role in the diagnosis of nephrotic syndrome, it is at the same time, one of the prominent causes of chronic renal failure. It has been indicated in many studies that ACEI's decrease proteinuria and that they are renoprotetctive. Our purpose in this study is to compare the effect of Losartan having similar effect mechanism with that of ACEI, effects on the proteinuria in nephrotic syndrome. This study was included 40 patients with primary and secondary glomerulary disease and those with nephrotic syndrome due to diabetic nephropathy and amyloidosis (14 F, 26 M). Nineteen patients (8 F, 11M) were given Enalapril 10 mg 1X1 and 21 of them were given losartan 50 mg 1X1. In the patients proteinuria was detected with sulfosalysilic acide method in Hitachi 717 autoanalysatore. Wilcoxon rank test, regression analysis test, Kruskal-Wallis variance analysis test were used with SPSS for windows 7.0 stastical evaluation. p< 0.05 was accepted for stastically significance value. Proteinuria has decreased significantly at the end of third month in the group used Enalapril in this study (p=0.002), and proteinuria levels have showed a significant decrease in second group patients using Losartan at the end of third month of the treatment (p=0.001). Both drugs have decreased proteinuria at the same level (p=0.107). It was seen that decrease in proteinuria in both groups was independent from the decrease in mean arterial blood pressure ( r= - 0.205, p= 0.400). Likewise, decrease in proteinuria in both groups did not change due to etiology causing nephrotic syndrome (p=0.915). Moreover decreased effects of the drugs on proteinuria were independent from age and sex (r=0.308, p=0.732; r=0.1 1, p=0.634). Blood total protein and albumin levels increased significantly in patients used Enalapril (p=0.01) and Losartan (p=0.001). Mean arteriel blood pressure showed a. significantly decrease with Enalapril (p=0.002) and Losartan (p=0.001). Both Enalapril52 and Losartan have decreased at the same level (p=0.70). No adverse effect was detected in both patients group due to Enalapril or Losartan. Consequently, it was observed that antiproteinuric effects of both drugs were similar and that this effect of these drugs were independent from antihypertensive effects. It can be said that the use of this drugs is an effective choice in symptomatic therapy of proteinuria in cases with nephrotic syndrome which do not respond to known treatment methods.