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Pharmaceuticals 2010, 3(1), 1-9; doi:10.3390/ph3010001
Article

Spironolactone Plus Full-Dose ACE Inhibition in Patients with Idiopathic Membranous Nephropathy and Nephrotic Syndrome: Does It Really Work?

1,2, 1,2, 1,2, 3 and 1,2,*
1 Clinical Research Center for Rare Diseases “Aldo e Cele Daccò”, Villa Camozzi, Ranica, Italy 2 Department of Medicine and Transplantation, Ospedali Riuniti-Mario Negri Institute for Pharmacological Research, Bergamo, Italy 3 Division of Nephrology, Department of Medicine, University of Alabama, Birmingham, Birmingham, AL 35294, USA
* Author to whom correspondence should be addressed.
Received: 2 December 2009 / Revised: 29 December 2009 / Accepted: 31 December 2009 / Published: 5 January 2010
(This article belongs to the Special Issue Antihypertensive Drugs)
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Abstract

We have studied the effects of add-on spironolactone treatment (100 mg/day) in 11 patients with idiopathic membranous nephropathy (IMN) and > 3 gm proteinuria/day despite angiotensin converting enzyme (ACE) inhibitor therapy titrated to a systolic/diastolic blood pressure < 120/80 mmHg. Blood pressure, 24-hour urinary protein excretion, and creatinine clearance were measured prior to, after two months of combined therapy, and after a 2-month withdrawal period of spironolactone. While systolic and diastolic blood pressure decreased significantly after spironolactone therapy, proteinuria did not improve. Serum potassium increased significantly as well, with three patients requiring resin-binding therapy. Thus, spironolactone seems to have no additional antiproteinuric effects over ACE inhibitor therapy in patients with IMN and nephrotic syndrome and carries the risk of significant hyperkalemia.
Keywords: idiopathic membranous nephropathy; spironolactone; proteinuria; hyperkalemia idiopathic membranous nephropathy; spironolactone; proteinuria; hyperkalemia
This is an open access article distributed under the Creative Commons Attribution License which permits unrestricted use, distribution, and reproduction in any medium, provided the original work is properly cited.

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Cravedi, P.; Brusegan, V.; Ruggenenti, P.; Campbell, R.; Remuzzi, G. Spironolactone Plus Full-Dose ACE Inhibition in Patients with Idiopathic Membranous Nephropathy and Nephrotic Syndrome: Does It Really Work? Pharmaceuticals 2010, 3, 1-9.

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