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  • Title: Oral calcitriol for the treatment of persistent proteinuria in immunoglobulin A nephropathy: an uncontrolled trial.
    Author: Szeto CC, Chow KM, Kwan BC, Chung KY, Leung CB, Li PK.
    Journal: Am J Kidney Dis; 2008 May; 51(5):724-31. PubMed ID: 18436082.
    Abstract:
    BACKGROUND: Laboratory research and previous retrospective study suggest that vitamin D and its analogues have profound effects on immune system function and glomerular mesangial cell proliferation. We conducted an open-label study to evaluate the antiproteinuric effect of calcitriol on proteinuria in patients with immunoglobulin A (IgA) nephropathy. STUDY DESIGN: Open-label prospective uncontrolled trial. SETTING & PARTICIPANTS: 10 patients (3 men) with biopsy-proven IgA nephropathy and persistent proteinuria despite angiotensin-converting enzyme-inhibitor or angiotensin receptor blocker therapy in a tertiary referral center. INTERVENTION: Calcitriol, 0.5 microg, twice weekly for 12 weeks. OUTCOME MEASURES: Changes in proteinuria, renal function, serum transforming growth factor beta (TGF-beta) and angiotensin II levels. RESULTS: After calcitriol treatment, there was a significant overall decrease in proteinuria with time by using a general linear model with repeated measures (P = 0.03). There was a progressive decrease in urine protein-creatinine ratio from 1.98 +/- 0.74 to 1.48 +/- 0.81 g/g (P = 0.007) during the first 6 weeks that persisted throughout the study period. No significant change in blood pressure or renal function was noted. There was a simultaneous decrease in serum TGF-beta level, and percentage of decrease in serum TGF-beta level significantly correlated with percentage of change in proteinuria (Spearman r = 0.643; P = 0.02). Serum angiotensin II level did not change throughout the study. One patient experienced transient hypercalcemia that normalized after a dosage decrease. No other major adverse effect was reported. LIMITATIONS: This small study is uncontrolled and does not examine the long-term effect of calcitriol therapy. CONCLUSION: Twice-weekly oral calcitriol has a modest antiproteinuric effect in patients with IgA nephropathy and persistent proteinuria despite angiotensin-converting enzyme-inhibitor or angiotensin receptor blocker therapy. Additional studies are needed to confirm the renal protecting effect of calcitriol in patients with chronic proteinuric kidney diseases.
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