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Controlled trials of Fish Oil
Randomized controlled trials evaluating fish oil
in patients with IgA nephropathy have reported conflicting
results [58-64] . The following two trials illustrate the range
of findings [58,61,64] :
In a trial from the Mayo Clinic, 106 patients
with baseline creatinine clearance 80 mL/min and protein
excretion of 2.5 to 3 g/day were randomly assigned to therapy
with either 12 g of omega-3 fish oil or a similar amount of
olive oil for two years [58] . There was no difference in blood
pressure control and no effect on protein excretion during the
study.
It is not clear why these trials produced
different results. One potentially important factor is that the
positive trial evaluated patients with more advanced disease
(more proteinuria and lower creatinine clearance at baseline),
and the placebo (olive oil) group had a faster rate of
progression than is generally seen. On the other hand, in the
negative trial, patients in the placebo group had lower baseline
proteinuria, a factor that is known to be associated with a
better prognosis [64] .
A meta-analysis evaluating five controlled
trials, which was published before the negative findings from
the Southwest Pediatric Nephrology Study Group, attributed much
of the variability in the reported results to differences in the
duration of follow-up [65] . When this difference was accounted
for statistically, a benefit with fish oil therapy was not found
to be significant, but a minor benefit was possible.
Summary — The benefit of fish oil has not been
established. Furthermore, the trial designs are not applicable
to current practice, since the patients were not treated with an
ACE inhibitor and/or ARB and, as necessary, other drugs to
recommended proteinuria and blood pressure goals. (See
"Treatment goals" above and see "Antihypertensive therapy and
progression of nondiabetic chronic kidney disease").
Fish oil can be tried in addition to ACE
inhibitors and/or ARBs in patients with protein excretion >500
to 1000 mg/day, a gradual reduction in GFR, and mild to moderate
histologic lesions [66] .
Lipid-lowering therapy — All patients with
decreased kidney function and/or hypercholesterolemia should
receive lipid-lowering therapy with a statin based upon the
following rationales:
Chronic kidney disease is associated with a
marked increase in cardiovascular risk, and is now considered a
coronary artery disease risk equivalent. (See "Chronic kidney
disease and coronary heart disease").
Lipid-lowering with statins has been associated
with a slower rate of loss of glomerular filtration rate in
patients with mild to moderate CKD. (See "Statins and chronic
kidney disease", section on Statins and CKD progression.
The goal LDL-cholesterol is similar to that in
patients with underlying coronary heart disease. (See "Intensity
of lipid lowering therapy in secondary prevention of coronary
heart disease"). There is a risk of
Rhabdomyolysis, one of the most dangerous Zocor
side effects, may be reversible once patients stop taking
the popular anti-cholesterol drug. Zocor rhabdomyolysis is
serious form of
muscle injury which causes muscle cells and fibers to enter
the bloodstream. The condition can induce compromised kidney
function and even cause death for certain individuals. However,
for some patients, merely discontinuing treatment with Zocor can
reverse the degenerative process as muscles heal.