Clinical role of small doses of Losartan and Enalapril in treatment of primary glomerulonephritis

Objective:To investigate the renal protection and protective effect of Losartan and Enalapril,an angiotensin converting enzyme inhibitor and an angiotensin receptor antagonist,at very small doses against proteinuria in primary glomerulonephritis.Methods:45 patients with primary glomerulonephritis were collected and assigned randomly into three groups: Losartan group (25 mg/d,n=15),Enalapril group (10 mg/d,n=15) and the combined treatment group (Losartan 25 mg plus Enalpril 10 mg/d,n=15).Urinery protein(UPE),serum uric acid,creatinine clearance rate (CCr) were determined and compared before,1 week and 12 weeks after the administration of the drugs.Results:A monotherapy with either Losartan or Enalapril significantly reduced the amount of protein discharged by 24.25% or 44.06% respectively.There was on significant difference between these two groups,while in combined therapy group,a more remarkable reduction of proteinuria (64.86%) was achieved with a statistically significant difference from the other two groups (P0.01).In all the three groups,reduction of UPE was not related with fall of blood pressure.Significant decrease in CCr was found in Enalapril treatment group after l and 12 weeks (P0.05),whereas no remarkable decline was found in the other two groups.Moreover,no changes in serum creatinine level and sodium excretion were observed in all the three groups.Conclusions:Small doses of Losartan and Enalapril would improve proteinuria in patients with primary glomerulonephritis; combined therapy of these two drugs could produce significantly greater anti-proteinuria effect than either one of the agents; Losartan had the weakest effect on CCr.