Angiotensin blockade as sole treatment for proteinuric kidney disease in children.
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.
Chandar
Jayanthi
J
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
Abitbol
Carolyn
C
Montané
Brenda
B
Zilleruelo
Gastón
G
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
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