Immunoglobulin A (IgA) nephropathy is the most common type of primary glomerulonephritis in
the world. Current treatment with angiotensin converting enzyme (ACE) inhibitor and
angiotensin receptor blocker (ARB) is not entirely effective. Aliskiren, a direct renin
inhibitor, acts on the rate limiting step of the renin-angiotensin axis. In addition to
lowering the blood pressure, recent study in diabetic nephropathy suggests an independent
anti-proteinuric effect. The investigators plan to conduct a randomized placebo-control
cross-over study to evaluate the safety and efficacy of aliskiren in the treatment of IgA
nephropathy. The investigators plan to recruit 57 patients with biopsy-proven IgA nephropathy
and persistent proteinuria despite conventional therapy. They will be randomized to aliskiren
for 16 weeks or no treatment, followed by cross over to the other arm after a washout period.
Proteinuria, albuminuria, renal function, serum and urinary markers will be quantified. This
study will explore the potential anti-proteinuric effect of aliskiren in the treatment of IgA
nephropathy, which has no specific treatment at present.