Ramipril and Proteinuria?

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Specializes in Community Health, Med-Surg, Home Health.

I had a patient I was counseling in my clinic and while reviewing medications, I mentioned to the client that Rampril was used for HTN (the most common use for me). The patient was shocked, saying that she is not hypertensive. To relax the client, I told her that many times, there are several uses for drugs and apologized to her for assuming. I trended her vitals and sure enough, she is usually about 122/84 at the worst. Read the doc's note and the exact reading for this was: proteinuria-will begin ramipril Got my drugbook and it seemed to say to me that proteinuria was a side effect of ramipril. Inquired with doctor and she told me that sometimes, they prescribed a low dose of Ramipril for proteinura.

Still have not seen this in my nursing drug guides. Can anyone enlighten me a bit further?

Thanks!

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I've read that Ramipril safely reduces proteinuria.

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Specializes in Community Health, Med-Surg, Home Health.

Thanks! I wonder why the recent drug guides (at least the 2008 and 2005 ones I have) have not mentioned this interesting tidbit.

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http://www.uninet.edu/cin2000/conferences/remuzzi/remuzzi.html

Analysis of the Ramipril Efficacy in Nephropathy (REIN) study [16], on the other hand, supports the concept that the renal protection conferred by ACE inhibitors exceeds the agents' antihypertensive effect. The REIN study was a randomized, double-blind, placebo-controlled trial designed to test whether glomerular protein traffic and its modification by an ACE inhibitor (ramipril) influenced renal disease progression in 352 patients with chronic non-diabetic nephropathies. A pre-stratification strategy recognized two levels of proteinuria (>1 but [/u]3 gr/24h) in patients randomly assigned the ramipril or conventional antihypertensive therapy. Treatment were targeted to the same level of blood pressure control (DBP

At the end of the REIN core study, patients with proteinuria of 3 gr or more per 24h, who either continued on ramipril or were shifted to ramipril, entered the REIN follow-up study. The results of the REIN follow-up study [17] indicated that ramipril slowed the rate of GFR decline and limited progression to ESRD even better than in the REIN core study, both in patients originally randomized to ramipril or conventional therapy (Figure 3).

Image3.gif Figure 3. Kidney survival in patients continued on or switched to ramipril during the whole (core and follow-up) study period of the REIN trial.

The novel finding of the Follow-up study was that GFR almost stabilized in patients originally randomized to ramipril who continued with the active drug for more than 36 months, indicating that if the treatment period is long enough the ACE inhibitor can reverse the tendency of GFR to decline.

http://www.ncbi.nlm.nih.gov/sites/entrez?cmd=Retrieve&db=PubMed&list_uids=9217756&dopt=AbstractPlus

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Specializes in Medical and general practice now LTC.

here in the UK we use it frequently with diabetic patients especially if proteinuria is discovered.Obviously monitoring of patient is done until deemed no side effect or problems with bp and U&E's

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Specializes in Community Health, Med-Surg, Home Health.

Emmanuel, have I told you I loved you lately? I'm about ready to treat you to a pair of new, comfortable shoes!!!

http://www.uninet.edu/cin2000/conferences/remuzzi/remuzzi.html

Analysis of the Ramipril Efficacy in Nephropathy (REIN) study [16], on the other hand, supports the concept that the renal protection conferred by ACE inhibitors exceeds the agents' antihypertensive effect. The REIN study was a randomized, double-blind, placebo-controlled trial designed to test whether glomerular protein traffic and its modification by an ACE inhibitor (ramipril) influenced renal disease progression in 352 patients with chronic non-diabetic nephropathies. A pre-stratification strategy recognized two levels of proteinuria (>1 but [/u]3 gr/24h) in patients randomly assigned the ramipril or conventional antihypertensive therapy. Treatment were targeted to the same level of blood pressure control (DBP

At the end of the REIN core study, patients with proteinuria of 3 gr or more per 24h, who either continued on ramipril or were shifted to ramipril, entered the REIN follow-up study. The results of the REIN follow-up study [17] indicated that ramipril slowed the rate of GFR decline and limited progression to ESRD even better than in the REIN core study, both in patients originally randomized to ramipril or conventional therapy (Figure 3).

Image3.gif Figure 3. Kidney survival in patients continued on or switched to ramipril during the whole (core and follow-up) study period of the REIN trial.

The novel finding of the Follow-up study was that GFR almost stabilized in patients originally randomized to ramipril who continued with the active drug for more than 36 months, indicating that if the treatment period is long enough the ACE inhibitor can reverse the tendency of GFR to decline.

http://www.ncbi.nlm.nih.gov/sites/entrez?cmd=Retrieve&db=PubMed&list_uids=9217756&dopt=AbstractPlus

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