Rafael Poveda

Publications (5)19.02 Total impact

• Article: Low-dose sirolimus combined with angiotensin-converting enzyme inhibitor and statin stabilizes renal function and reduces glomerular proliferation in poor prognosis IgA nephropathy.

  Josep M Cruzado, Rafael Poveda, Meritxell Ibernón, Montserrat Díaz, Xavier Fulladosa, Marta Carrera, Joan Torras, Oriol Bestard, Itziar Navarro, José Ballarín, Ramón Romero, Josep M Grinyó
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  ABSTRACT: There is a lack of new therapeutic strategies for IgA nephropathy. Low-dose sirolimus inhibits mesangial cell proliferation and renal fibrosis in animal models. We performed a pilot, randomized controlled trial to evaluate the efficacy and safety of low-dose sirolimus in patients with a high-risk IgA nephropathy. Twenty-three patients with a glomerular filtration rate (GFR) within 30-60 mL/min and/or proteinuria >1 g/day were randomly assigned to low-dose sirolimus plus enalapril and atorvastatin (SRL group, n = 14) or enalapril plus atorvastatin (CONTROL group, n = 9). Primary composite end point was variation of haematuria, proteinuria and blood pressure. Secondary end points were isotopic GFR, renal histology evaluated by Oxford classification and safety parameters evaluated at 6 and 12 months. Primary end point improved significantly in the SRL group at 12 months. Regarding isotopic GFR, patients included in the CONTROL group lost 8 mL/min/1.73 m(2), whereas those in the SRL arm improved 5 mL/min/1.73 m(2) (P = 0.03). Proteinuria decreased similarly in both study groups. At 1 year, SRL treatment was associated with a significant reduction of mesangial and endocapillary proliferation, whereas glomerular sclerosis, tubular atrophy and interstitial fibrosis were similar. Sirolimus was well tolerated; all patients remained on therapy at 12 months. The addition of low-dose sirolimus to enalapril and statin is safe, stabilizes renal function and reduces glomerular proliferative lesions in patients with poor prognosis IgA nephropathy.
  Nephrology Dialysis Transplantation 03/2011; 26(11):3596-602. · 3.40 Impact Factor
• Source

  Available from: oxfordjournals.org

  Article: Acute renal failure associated to renin angiotensin system (RAS) inhibitors--its burden in a nephrology department.

  Itziar Navarro, Rafael Poveda, Joan Torras, Alberto M Castelao, Josep M Grinyó
  Nephrology Dialysis Transplantation 02/2008; 23(1):413-4. · 3.40 Impact Factor
• Article: Treatment of idiopathic membranous nephropathy with the combination of steroids, tacrolimus and mycophenolate mofetil: results of a pilot study.

  José Ballarin, Rafael Poveda, Jordi Ara, Laureà Pérez, Francesca Calero, Josep M Grinyó, Ramón Romero
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  ABSTRACT: Membranous nephropathy is a common cause of nephrotic syndrome (NS) in adults. Its treatment is still under debate. We report our experience in a pilot study using initially low doses of steroids and tacrolimus (Tac). After 3 months of treatment, mycophenolate mofetil (MMF) was added if the proteinuria was higher than 1 g/day. In accordance with this standard, 21 patients entered the study. A proteinuria level lower than 1 g/day was reached at month 3 of therapy with steroids and Tac in 11 patients. These patients continued this treatment for 12 months. MMF was added in nine cases after the third month and triple therapy was maintained for 12 more months. Two patients were withdrawn because of side effects. At the end of the treatment, remission of the NS was present in 15 out of all the patients (71.4%). Remission of the NS was complete in eight (53.3%) patients and partial in seven (46.7%) others. The remaining four patients did not respond. There were no significant changes in renal function. At a mean time of 23.1 months after treatment was discontinued, 11 (73.3%) patients had relapsed. In this trial, treatment with tacrolimus showed a good efficacy but a high relapse rate when it was discontinued.
  Nephrology Dialysis Transplantation 12/2007; 22(11):3196-201. · 3.40 Impact Factor
• Article: Renal involvement in non-malignant IgM gammopathy.

  Rosa Ramos, Rafael Poveda, Josep Sarrá, Alicia Domingo, Luís Carreras, Josep M Grinyó
  Nephrology Dialysis Transplantation 03/2007; 22(2):627-30. · 3.40 Impact Factor
• Article: Goodpasture syndrome during the course of a Schönlein-Henoch purpura.

  Luis Carreras, Rafael Poveda, Jordi Bas, Mariona Mestre, Inés Rama, Marta Carrera
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  ABSTRACT: Two months after surgical resection of a bronchogenic carcinoma, a 69-year-old patient presented with Schönlein-Henoch purpura with kidney involvement followed by pulmonary hemorrhage. The presence of an IgA linear pattern on the kidney biopsy specimen and circulating anti-glomerular basement membrane (GBM) IgA antibodies led to the diagnosis of Goodpasture syndrome, which implies the possibility that the well-known pulmonary involvement during the course of Schönlein-Henoch purpura could be caused by Goodpasture syndrome in certain cases. In cases of glomerulonephropathy with lung involvement, clinicians should not limit their investigations to anti-GBM IgG.
  American Journal of Kidney Diseases 06/2002; 39(5):E21. · 5.43 Impact Factor