The benefits of renin-angiotensin blockade in renal transplant recipients with biopsy-proven allograft nephropathy

Background. Allograft nephropathy, regardless of aetiology, leads to progressive renal injury and eventual graft loss. In native kidney disease, treatment of hypertension, in particular with angiotensin-converting enzyme inhibitors (ACEi) or angiotensin receptor blockers (ARB), has proven beneficial in retarding renal function decline. In the present study, we reviewed the clinical course of a renal transplant recipient cohort that was prescribed either an ACEi or ARB for biopsy-proven allograft nephropathy. Methods. Patients were followed from the time of post-biopsy initiation of ACEi/ARB and were stratified based on biopsy findings. Outcomes of interest included safety, allograft survival, renal function and change in slope of renal function pre- and post-ACEi/ARB. Results. The 5 year allograft survival after biopsy diagnosis of allograft nephropathy was 83%. Serum creatinine was 191 +/- 97 (86-377) mumol/l at the time of biopsy and 228 +/- 102 (102-575) mumol/l at last follow-up. The slopes of reciprocal creatinine vs time were used to calculate the decline in renal function and were compared pre- and post-ACEi/ARB. The mean slope +/- SD was -0.06 +/- 0.21 l/mumol x 10(-3) per month in the 12 months prior to therapy and -0.03 +/- 0.09 l/mumol X 10-3 per month following therapy. The absolute difference in slopes was 0.03 (P = < 0.0001). Conclusions. Treatment with ACEi/ARB may be beneficial in the management of allograft nephropathy.