Inhibitors of Angiotensin II in Proteinuric Mesangioproliferative Glomerulonephritis

After signing informed consent, enrolled patients started treatment with ACEi. We decided to prescribe to all patients the same drug (ramipril) at the same dosage (5 mg/day). All patients were examined every 2 months during the first year of follow-up and every 6 months thereafter. At each visit, they underwent a complete physical examination. If the target blood pressure of <140/90 mmHg was not achieved with ramipril monotherapy, addition of other antihypertensive drug(s) was allowed. Patients complaining adverse side effects attributed to ramipril were switched to losartan (50 mg/day). The patients were also prescribed a normal protein (1 gram/kg/day) and moderately salt-restricted (6-8 grams/day) diet throughout the study.

Inclusion criteria

• proteinuria ≥ 1 g and < 3 g/24 hours stable during the 3 months of run-in
• microscopic hematuria (with at least 10 red blood cells per high-power field), without other signs or symptoms of systemic diseases stable during the 3 months of run-in
• no-evidence of renal failure or other relevant diseases
• biopsy diagnosis of I-II stage IgA- or pauciimmune-MsPGN

Exclusion criteria

• estimated Glomerular Filtration Rate (eGFR) <80 ml/min/1.73m2
• previous immunosuppressive treatment
• blood pressure (BP) >150/90 mmHg