Management of Albuminuria with Angiotensin II Receptor Antagonists

Efficacy of Losartan in Reducing Albuminuria

The American Journal of Kidney Diseases recommends the use of Angiotensin II Receptor Antagonists (ARA2) such as losartan for patients with diabetes and albuminuria, especially those with macroalbuminuria (>300 mg/g), with a response rate of 100% in patients with micro and macroalbuminuria 1, 2
Losartan has been shown to reduce albuminuria in patients with diabetes and nephropathy, with a significant reduction in proteinuria, according to the American Journal of Kidney Diseases 3, 4

The American Journal of Kidney Diseases and Diabetes Care recommend the use of ARA2, such as losartan, for patients with diabetes and albuminuria, especially those with macroalbuminuria (>300 mg/g) 4, 5
For patients with microalbuminuria (30-299 mg/g), the use of ARA2 may be considered, although the evidence is less robust, according to the American Journal of Kidney Diseases and Diabetes Care 4, 5

The American Journal of Kidney Diseases and Blood advances recommend evaluating renal function and potassium levels within the first week of initiating treatment or after any dose increase, and suspending medication temporarily during intercurrent illnesses or IV radiocontrast administration 6
The combination of ACE inhibitors and ARA2 is not recommended due to increased risk of adverse events such as hyperkalemia and acute kidney injury, according to the American Journal of Kidney Diseases and Diabetes Care 5, 7

ARA2, such as losartan, have also shown benefits in reducing albuminuria in patients with sickle cell disease and albuminuria, according to Blood advances 1, 2, 6
The benefits of losartan in reducing albuminuria and slowing disease progression are observed independently of age, gender, and race, although the evidence is more robust for patients with diabetes type 2 and nephropathy, according to the American Journal of Kidney Diseases 3, 4