End-stage renal failure Surgery Failing kidney transplant, proteinuria
Conditions
Interventions
Use of Lisinopril in the active limb only (dose used titrated in individual patients to achieve maximum reduction in proteinuria without leading to postural hypotension).
Control: usual care
There is
Sponsors
Royal Liverpool and Broad Green University Hospitals NHS Trust (UK)
Eligibility
Sex/Gender
All
Inclusion criteria
Inclusion criteria: 1. Biopsy proven CAN at least 6 months post kidney transplantation - both cadaveric and live-related. Each biopsy will be independently examined and the severity graded by an experienced pathologist 2. Not on ACE-inhibitor (or angiotensin II antagonists) treatment 3. Patients may be on any combination of immunosuppressive therapy. However, those who have been converted to tacrolimus or mycophenolate mofetil after diagnosis of CAN within 6 months are excluded 4. Proteinuria of more than 1.0 g/24 hours 5. Mean creatinine clearance >20 ml/min 6. No history of a transient ischaemic or cardiovascular event or malignancy in the last 6 months 7. Patients aged between 18-70 years
Exclusion criteria
Exclusion criteria: 1. Patients with clinical or histological evidence or acute rejection in the last 3 months 2. Patients with evidence of renal artery stenosis 3. Persistently high cyclosporin or tacrolimus levels 4. Abnormal liver function tests 5. Pregnant or ineffective contraception 6. Chronic intractable cough
Design outcomes
Primary
| Measure | Time frame |
|---|---|
| Preservation of glomerular filtration rate (GFR) ml/min. | — |
Secondary
| Measure | Time frame |
|---|---|
| 1. Reduction in proteinuria 2. Sub-group analyses: 2.1 Effects on tubular metabolism of aprotinin (lisinopril limb only) 2.2 Urinary NAG, MCP-1, TGF-Beta 2.3 Plasma markers of oxidative stress 2.4 ACE genotyping | — |
Countries
United Kingdom
Outcome results
None listed