Supportive management of IgA nephropathy with renin-angiotensin blockade, the AIIMS Primary IgA Nephropathy cohort (APPROACH) study

Abstract Background Renin-angiotensin system (RAS) blockade using ACEi/ARBs is first line therapy for IgA nephropathy (IgAN). There is paucity of information on the predictors and magnitude of response to this treatment. Methods In a prospective study, treatment naive patients with IgAN having urinary protein≥1g/day and eGFR≥30ml/min/1.73m2 received supportive treatment including ACEi(Ramipril) or ARB(Losartan) in patients intolerant to ACEi and optimal blood pressure(BP) control to ≤130/80 mm Hg with follow-up of 6 months. The primary outcome was remission of proteinuria. Complete remission (CR) was defined as proteinuria Results 96 patients were analysed withmean age of 33.3±10.2 years, baseline eGFR-74.0 ± 30.9ml/min/1.73m2 and urinary protein- 2.6±1.2g/day. 71.9% patients received ≥75% of the maximum approved dose of ACEi/ARB. Remission was observed in 36.5%(CR-6.3%) patients at 3 months and 55.2%(CR-31.3%) at 6 months. Patients who failed to achieve remission had lower baseline eGFR(p=0.002) and serum albumin levels(p Conclusion Meticulous supportive therapy with optimization of ACEi/ARB achieved remission in half of IgAN patients. Increasing the treatment duration to 6 months improves remission rates. Patients with severe clinical and histological disease are less likely to tolerate and respond to treatment with RAS blockade.