Renin-angiotensin-aldosterone system (RAAS) inhibitors generally cause a reduction in proteinuria in patients with primary focal segmental glomerulosclerosis (FSGS), according to study findings published recently in Kidney Medicine. Maintained kidney function was also associated with RAAS inhibitor monotherapy.  

Reducing protein in urine with RAAS inhibitor therapies may be helpful in treatment of primary FSGS, which can lead to kidney damage or failure. Efficacy and safety of RAAS inhibitor therapies in primary and genetic FSGS have not been established. Researchers sought to examine RAAS inhibitors and FSGS kidney outcomes.

Kirk M. Campbell, MD, of the Icahn School of Medicine at Mount Sinai in New York, New York, and colleagues conducted a systematic review and meta-analysis of 30 studies of patients with primary and genetic FSGS gathered from PubMed, Embase, and Cochrane Library databases.


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RAAS inhibitor monotherapy was significantly associated with a 32% reduction in proteinuria from baseline to the final follow-up, but no change in creatinine clearance, Dr Campbell’s team reported.A RAAS inhibitor used in conjunction with other medications was significantly associated with a 72% reduction in proteinuria. The data in the assessed publications was not appropriate to gage RAAS inhibitor monotherapy on end-stage kidney disease or estimated glomerular filtration rate.

Researchers concluded that their review “supports the tendency to observe a proteinuria reduction with RAAS inhibitors in patients with primary FSGS. RAAS inhibitor monotherapy was associated with maintained kidney function.” They asserted that the potential for clinical benefit is suggested by RAAS inhibitor therapies that produce incremental reduction in proteinuria.

Study limitations include heterogeneity in design, patient population, and treatment across studies, and no risk-of-bias assessment was made. The majority of the assessed publications studied RAAS inhibitor treatment in combination with other drugs, thus making RAAS inhibitor reductions impossible to distinguish as independent events in those studies.

Disclosure: This research was supported by Travere Therapeutics, Inc. Some study authors declared affiliations with biotech, pharmaceutical, and/or device companies. Please see the original reference for a full list of authors’ disclosures.

Reference

Campbell KN, Pennese N, Zaffalon A, et al. Efficacy and safety of ACE inhibitor and angiotensin receptor blocker therapies in primary focal segmental glomerulosclerosis treatment: A systematic review and meta-analysis. Kidney Med. Published online March 24, 2022. doi:10.1016/j.xkme.2022.100457