title: Angiotensin blockade as sole treatment for proteinuric kidney disease in children.
abstract: BACKGROUND
  The traditional management of children with proteinuric kidney disease is treatment with high dose steroids regardless of comorbid conditions such as obesity. This study evaluated the effect of angiotensin blockade (AB) alone as the sole management of children with non-diabetic proteinuric kidney disease.
  
  
  METHODS
  Retrospective chart analysis was performed in 146 children. Seventeen were identified to have received angiotensin-converting enzyme inhibitor and/or angiotensin receptor blocker exclusively for management of proteinuria. Total proteinuria (Upr/cr), albuminuria (Ualb/cr), estimated glomerular filtration rate (eGFR), serum potassium and blood pressure were assessed at baseline and at 3-month intervals for over 24 months.
  
  
  RESULTS
  Mean age was 11.2+/-4.8 years with 12 females. Eleven of 17 patients (65%) were overweight or obese. There was a significant decline in total proteinuria and albuminuria after 3-6 months of AB therapy and a further decline with longer duration of treatment (P<0.001). Although single vs dual AB were similarly effective in lowering total proteinuria, dual therapy was more effective in lowering albuminuria (single 57+/-23% vs dual 71+/-15%; P<0.02). The eGFR decreased from 'hyperfiltration' levels prior to initiation of AB to normal at the end of the treatment period (145+/-41-111+/-17 ml/min/1.73 m2; P=0.01). Systemic blood pressures remained normal throughout the study period.
  
  
  CONCLUSIONS
  Angiotensin blockade alone appears to effectively control proteinuria and stabilize kidney function in children. This may provide an alternative to more toxic therapies, especially corticosteroids, in children with glomerular disorders such as those associated with obesity.
authors.affiliation: Department of Pediatrics, Division of Paediatric Nephrology, University of Miami/Holtz Children's Hospital, P.O. Box 016960 (M-714), Miami, Florida 33101, USA. jchanda2@med.miami.edu
authors.forename: Jayanthi
authors.initials: J
authors.lastname: Chandar
authors.forename: Carolyn
authors.initials: C
authors.lastname: Abitbol
authors.forename: Brenda
authors.initials: B
authors.lastname: Montané
authors.forename: Gastón
authors.initials: G
authors.lastname: Zilleruelo
mesh_terms: D000293:Adolescent; D047228:Angiotensin II Type 1 Receptor Blockers / Q000627:therapeutic use*; D000806:Angiotensin-Converting Enzyme Inhibitors / Q000627:therapeutic use*; D000809:Angiotensins / Q000037:antagonists & inhibitors* / Q000502:physiology; D001562:Benzimidazoles / Q000627:therapeutic use; D001713:Biphenyl Compounds; D001794:Blood Pressure / Q000502:physiology; D002648:Child; D004305:Dose-Response Relationship, Drug; D004359:Drug Therapy, Combination; D004656:Enalapril / Q000627:therapeutic use; D005260:Female; D005919:Glomerular Filtration Rate / Q000502:physiology; D006801:Humans; D007674:Kidney Diseases / Q000188:drug therapy* / Q000503:physiopathology; D019808:Losartan / Q000627:therapeutic use; D008297:Male; D011507:Proteinuria / Q000188:drug therapy* / Q000503:physiopathology; D012189:Retrospective Studies; D013777:Tetrazoles / Q000627:therapeutic use
chemical_list: D047228:Angiotensin II Type 1 Receptor Blockers; D000806:Angiotensin-Converting Enzyme Inhibitors; D000809:Angiotensins; D001562:Benzimidazoles; D001713:Biphenyl Compounds; D013777:Tetrazoles; D004656:Enalapril; D019808:Losartan; C081643:candesartan