title: Additive antiproteinuric effect of enalapril and losartan in children with hemolytic uremic syndrome.
abstract: BACKGROUND
  Angiotensin-converting enzyme inhibitors or angiotensin II type 1 receptor blockers decrease postdiarrheal hemolytic uremic syndrome (D + HUS) sequelar proteinuria. However, proteinuria may persist in some patients. In nephropathies other than D + HUS, an additive antiproteinuric effect with coadministration of both drugs has been observed.
  
  
  METHODS
  To assess such an effect in D + HUS, 17 proteinuric children were retrospectively studied. After a median period of 1 year post-acute stage (range 0.5-1.9) patients received enalapril alone for a median of 2.6 years (range 0.33-12.0) at a median dose of 0.4 mg/kg/day (range 0.2-0.56). As proteinuria persisted, losartan was added at a median dose of 1.0 mg/kg/day (range 0.5-1.5) during 2.1 years (range 0.5-5.0).
  
  
  RESULTS
  The decrease in proteinuria with enalapril was 58.0 %, which was further reduced to 83.8 % from the initial value after losartan introduction. The percentage of reduction was significantly greater with the association of both drugs (p = 0.0006) compared with the effect of enalapril exclusively (p = 0.023). Serum potassium, glomerular filtration rate, and blood pressure remained unchanged.
  
  
  CONCLUSIONS
  Our results suggest that adding losartan to persisting proteinuric D + HUS children already on enalapril is safe and reduces proteinuria more effectively. Whereas this effect is associated with long-term kidney protection, it should be determined by prospective controlled studies.
authors.affiliation: Department of Nephrology, Hospital de Pediatría Prof. Dr. Juan P. Garrahan, Combate de los Pozos 1881, Buenos Aires, Argentina. mariacaletti@garrahan.gov.ar.
authors.forename: María Gracia
authors.initials: MG
authors.lastname: Caletti
authors.forename: Alejandro
authors.initials: A
authors.lastname: Balestracci
authors.forename: Mabel
authors.initials: M
authors.lastname: Missoni
authors.forename: Clarisa
authors.initials: C
authors.lastname: Vezzani
mesh_terms: D047228:Angiotensin II Type 1 Receptor Blockers / Q000009:adverse effects / Q000627:therapeutic use; D000806:Angiotensin-Converting Enzyme Inhibitors / Q000009:adverse effects / Q000627:therapeutic use*; D002648:Child; D002675:Child, Preschool; D003967:Diarrhea / Q000150:complications / Q000175:diagnosis / Q000188:drug therapy*; D004359:Drug Therapy, Combination; D004656:Enalapril / Q000009:adverse effects / Q000627:therapeutic use*; D005260:Female; D006463:Hemolytic-Uremic Syndrome / Q000150:complications / Q000175:diagnosis / Q000188:drug therapy*; D006801:Humans; D007223:Infant; D019808:Losartan / Q000009:adverse effects / Q000627:therapeutic use*; D008297:Male; D011507:Proteinuria / Q000175:diagnosis / Q000188:drug therapy* / Q000209:etiology; D012189:Retrospective Studies; D013997:Time Factors; D016896:Treatment Outcome
chemical_list: D047228:Angiotensin II Type 1 Receptor Blockers; D000806:Angiotensin-Converting Enzyme Inhibitors; D004656:Enalapril; D019808:Losartan