Chronic Allograft Nephropathy - an Indian Study

Abstract

Introduction: Chronic allograft nephropathy(CAN) is a major cause of late graft loss. Multiple factors have been implicated in the pathogenesis of CAN thus making the treatment of this entity equally difficult. Recent evidence has suggested involvement of Aldosterone in progression of Renal fibrosis. Hence this study was carried out for Aldactone (Spironolactone) as a novel form of therapy. Material and methods: A total of 72 patients during the study period from Aug 2004 to May 2011 with biopsy proven Chronic Allograft Nephropathy were randomized to receive Aldactone(Spironolactone) -(group A) & placebo-(group B) in addition to immunosuppressive & other medication. Group A received 25 mg of Aldactone. Investigations in the form of biochemical parameters including serum creatinine, proteinuria, GFR, C-reactive protein were studied in both the groups at the beginning and after 6 months and yearly thereafter. Follow up allograft biopsy could not be done in all the cases because of various reasons. The patients were followed up (minimum 1 year and maximum 6 years) on continued treatment from Aug 2004 to May2011. Results: Serum creatinine remained stable in Group A patients(p=0.020). GFR as measured with DTPA renal allograft scintigraphy showed a significant improvement (p=0.003) as compared to Group B patients. Changes in GFR correlated positively with decline in proteinuria & albuminuria (p=0.04) in Group A patients. The graft function progressively deteriorated in Group B patients (p=0.04). There was no significant hyperkalemia noted in thegroup A patients. There was no significant correlation of CRP levels with level of GFR(p=0.65), noted. The base line characterstics of both the groups were similar. Conclusions: The present study reveals benefit of using Aldactone (Spironolactone) in patients having Chronic Allograft Nephropathy resulting in significant improvement of graft function. It was well tolerated without any significant hyperkalemia.It is a novel, easily acceptable & cost effective form of therapy for CAN. This is the first Double blind, placebo controlled, randomized, prospective study using Aldactone for CAN from India & is a part of ongoing study.