From the Guidelines
Patients with proteinuria >0.5 g/d should be initially treated with either an angiotensin-converting enzyme inhibitor (ACEi) or angiotensin II receptor blocker (ARB) to manage their condition effectively. Medications commonly used to treat protein in urine (proteinuria) include angiotensin-converting enzyme (ACE) inhibitors and angiotensin II receptor blockers (ARBs) as per the recommendation by the American Journal of Kidney Diseases 1. These medications work by reducing pressure within the kidneys' filtering units and decreasing inflammation, which helps lower protein leakage. Key points to consider when treating proteinuria include:
- Managing blood pressure as described in the relevant guidelines
- Initial therapy with either an ACEi or ARB for patients with proteinuria >0.5 g/d, as recommended in the 2021 KDIGO clinical practice guideline for the management of glomerular diseases 1
- Regular monitoring of kidney function, blood pressure, and urine protein levels
- Lifestyle modifications such as limiting dietary sodium, maintaining healthy blood pressure and blood sugar levels, achieving a healthy weight, and avoiding smoking. The choice of medication and treatment approach may vary depending on the underlying cause of proteinuria, such as diabetes, high blood pressure, glomerulonephritis, or other kidney diseases, but ACEi or ARB therapy is the recommended initial treatment for patients with significant proteinuria, as supported by the 2023 study published in the American Journal of Kidney Diseases 1.
From the FDA Drug Label
Losartan is indicated for the treatment of diabetic nephropathy with an elevated serum creatinine and proteinuria (urinary albumin to creatinine ratio ≥300 mg/g) in patients with type 2 diabetes and a history of hypertension Compared with placebo, losartan significantly reduced proteinuria by an average of 34%, an effect that was evident within 3 months of starting therapy
Medication for protein in urine:
- Losartan is used to treat proteinuria (urinary albumin to creatinine ratio ≥300 mg/g) in patients with type 2 diabetes and a history of hypertension.
- It reduces proteinuria by an average of 34%.
- The effect of losartan on proteinuria is evident within 3 months of starting therapy 2.
From the Research
Medication for Protein in Urine
- The primary goal in managing proteinuria is to reduce proteinuria and slow the progression of kidney disease 3, 4, 5.
- Angiotensin-converting enzyme (ACE) inhibitors and angiotensin receptor blockers (ARBs) are widely accepted as the most effective antiproteinuric and renoprotective interventions 3, 4, 6, 5.
- Combination therapy of ACE inhibitors and ARBs has been shown to be more effective in reducing proteinuria than monotherapy 4, 6.
- The addition of a statin to a combination of ACE inhibitor and ARB has been shown to normalize proteinuria and provide full renoprotection in experimental diabetes 7.
- Different ACE inhibitors and ARBs have varying levels of efficacy in reducing proteinuria, with some having a higher probability of being the most effective treatment 6.
- The choice of medication should be based on the individual patient's needs and the underlying cause of proteinuria, with consideration given to the potential benefits and harms of each treatment option 3, 6, 5.
Treatment Options
- ACE inhibitors, such as lisinopril and enalapril, have been shown to be effective in reducing proteinuria 3, 4, 6, 5.
- ARBs, such as olmesartan and candesartan, have also been shown to be effective in reducing proteinuria 3, 4, 6.
- Combination therapy of ACE inhibitors and ARBs, such as olmesartan plus temocapril, has been shown to be more effective in reducing proteinuria than monotherapy 4, 6.
- Statins, such as rosuvastatin, have been shown to be effective in normalizing proteinuria and providing full renoprotection in experimental diabetes when added to a combination of ACE inhibitor and ARB 7.