title: Renin-angiotensin-aldosterone system inhibitors in pediatric focal segmental glomerulosclerosis.
abstract: BACKGROUND
  Conventional immunosuppressive therapy for primary pediatric focal segmental glomerulosclerosis (FSGS) is potentially toxic and only moderate evidence supports its effectiveness. Renin-angiotensin-aldosterone (RAAS) inhibition monotherapy is anecdotally used in selected patients as an alternative to conventional therapy.
  
  
  METHODS
  We performed a retrospective cohort study of children with primary FSGS seen at a tertiary care academic hospital between 1986 and 2008. We classified patients into two groups based upon initial treatment: RAAS inhibition monotherapy (RIM) and conventional therapy (CT). The primary endpoint was progression to end-stage renal disease (ESRD). Secondary endpoints were remission of proteinuria, relapse, and death.
  
  
  RESULTS
  The cohort consisted of 67 patients. Mean baseline urine protein/creatinine ratio (Up/c) was 8.0 (5.2, 10.7) mg/mg, and mean baseline estimated glomerular filtration rate (eGFR) was 115.0 (101.8, 128.1) mL/min/1.73 m(2). Patients in the RIM group were more likely to have lower eGFR (100.8 mL/min/1.73 m(2) vs 132.9 mL/min/1.73 m(2), p = 0.01) and less proteinuria (4.4 vs.14.4, p < 0.01). Renal failure occurred in 22.9% of the RIM group vs 40.6% in the CT group (log-rank p = 0.07). After adjustment for African-American race, time period of presentation, baseline age, eGFR, and Up/c, patients in the RIM group had a 0.11 hazard ratio of progressing to renal failure compared with patients in the CT group (p < 0.01).
  
  
  CONCLUSIONS
  Children treated initially with RIM may have better outcomes than those treated with CT.
authors: Robert Wood Johnson VA Clinical Scholars Program, Department of Veterans Affairs, Philadelphia VA Medical Center, 13th floor Blockley Hall, 423 Guardian Drive, Philadelphia, PA 19104, USA. kangovi@mail.med.upenn.edu
authors: Shreya
authors: S
authors: Kangovi
authors: Meredith
authors: M
authors: Edwards
authors: Stephen
authors: S
authors: Woloszynek
authors: Nandita
authors: N
authors: Mitra
authors: Harold
authors: H
authors: Feldman
authors: Bernard S
authors: BS
authors: Kaplan
authors: Kevin E
authors: KE
authors: Meyers
mesh_terms: D000293:Adolescent; D001794:Blood Pressure; D002648:Child; D015331:Cohort Studies; D005260:Female; D005919:Glomerular Filtration Rate; D005923:Glomerulosclerosis, Focal Segmental / Q000188:drug therapy*; D006801:Humans; D007166:Immunosuppressive Agents / Q000627:therapeutic use; D053208:Kaplan-Meier Estimate; D007677:Kidney Function Tests; D008297:Male; D011507:Proteinuria / Q000209:etiology; D051437:Renal Insufficiency / Q000209:etiology; D012084:Renin-Angiotensin System / Q000187:drug effects*; D012189:Retrospective Studies; D016019:Survival Analysis; D016896:Treatment Outcome
chemical_list: D007166:Immunosuppressive Agents