Effects of co-administration of urokinase and benazepril on severe IgA nephropathy

Background. The availability of treatment for IgA nephropathy (IgAN) is limited. Method. A prospective randomized controlled clinical trial was performed to evaluate the effects of therapy with urokinase (UK) and benazepril (BZ, an angiotensin-converting enzyme inhibitor) or BZ alone on severe IgAN. We divided 71 cases of IgAN, Lee's grade greater than or equal toIII and with fibrinogen deposits, into two groups to be treated for 12 months with either UK + BZ or BZ alone. Results. There was no significant difference between the two groups in baseline clinical and histopathological data. After 12 months of treatment, 25 of 35 patients (71.4%) in the UK + BZ group and 16 of 36 (44.4%) in the BZ-alone group had a greater than or equal to50% decrease in 24-h urinary protein excretion compared with the baseline (chi(2) test, P < 0.05). Proteinuria significantly decreased at 6 and 12 months of treatment in both groups compared with baseline (P < 0.01 in the UK + BZ group, P < 0.05 in the BZ group), and the therapeutic efficiency of UK + BZ was better than that of BZ alone (P < 0.05 at 6 and 12 months). The endogenous creatinine clearance rate (Ccr) was stable in the UK + BZ group, while Ccr declined significantly at 6 and 12 months in the BZ-alone group compared with baseline (P < 0.05, respectively). The Ccrs of the two groups at 12 months of treatment were statistically different (P < 0.05). Conclusions. Combined therapy with UK and BZ was more effective than with BZ alone in reducing proteinuria and protecting renal function in patients with severe IgAN.