Enalapril and prednisone in children with nephrotic-range proteinuria.
The effect of enalapril and low prednisone doses on the urinary protein electrophoretic pattern was studied in 13 pediatric patients with glomerular diseases and steroid-resistant nephrotic syndrome. Enalapril was administered at doses of 0.2-0.6 mg/kg per day for 24-84 months, and prednisone was introduced 2 months later in 11 patients at doses of 30 mg/m2 on alternate days. The urine protein electrophoretic pattern showed a reduction of 80% and 70% in the total protein and albumin, respectively, after enalapril. Total urinary protein decreased from 5.46 to 1.1 g/m2 per day (P<0.001). A marked change from a pattern of non-selective urinary protein loss to an albumin-selective proteinuria was observed. Mean total plasma proteins increased from 4.7 to 5.43 g/dl (P<0.001). Four patients became free of proteinuria 24 months after enalapril was started, but only 2 remained free of proteinuria at 48 months of follow-up. The other 11 patients had persistent albuminuria of between 0.5 and 2.6 g/m2 per day with a selective urinary electrophoretic pattern. No additional decrease was observed after steroids were introduced. A clinical improvement in edema was observed in all children. Three patients developed transient acute renal failure, during the course of an infectious disease; 2 developed peritonitis and 1 pneumopathy. In these patients withdrawal of enalapril was necessary until a complete recovery of renal function was observed. Four patients were hypertensive on admission, achieving normal blood pressure 1 month after enalapril was started. No episodes of systemic arterial hypotension were seen. Creatinine clearance and serum potassium showed no statistically significant change.
Delucchi
A
A
Division of Pediatric Nephrology, Hospital Luis Calvo Mackenná, Universidad de Chile, Santiago. delucchi@cmet.net
Cano
F
F
Rodriguez
E
E
Wolff
E
E
Gonzalez
X
X
Cumsille
M A
MA
D000806:Angiotensin-Converting Enzyme Inhibitors / Q000009:adverse effects / Q000627:therapeutic use*; D001798:Blood Proteins / Q000032:analysis; D002648:Child; D002675:Child, Preschool; D003404:Creatinine / Q000097:blood; D004305:Dose-Response Relationship, Drug; D004351:Drug Resistance; D004359:Drug Therapy, Combination; D004587:Electrophoresis, Agar Gel; D004656:Enalapril / Q000009:adverse effects / Q000627:therapeutic use*; D005938:Glucocorticoids / Q000008:administration & dosage / Q000627:therapeutic use*; D006801:Humans; D007223:Infant; D007674:Kidney Diseases / Q000150:complications; D007678:Kidney Glomerulus; D008297:Male; D009404:Nephrotic Syndrome / Q000097:blood / Q000209:etiology / Q000652:urine*; D011241:Prednisone / Q000627:therapeutic use*; D011507:Proteinuria / Q000188:drug therapy* / Q000209:etiology / Q000652:urine; D013256:Steroids / Q000627:therapeutic use*
D000806:Angiotensin-Converting Enzyme Inhibitors; D001798:Blood Proteins; D005938:Glucocorticoids; D013256:Steroids; D004656:Enalapril; D003404:Creatinine; D011241:Prednisone