title: Effect of enalapril on glomerular filtration rate and proteinuria in children with chronic kidney disease: a randomized controlled trial.
abstract: OBJECTIVE
  To evaluate the efficacy of enalapril treatment on decline in glomerular filtration rate and reduction in proteinuria in children with chronic kidney disease (CKD).
  
  
  METHODS
  Open-label, randomized controlled trial.
  
  
  METHODS
  Pediatric nephrology clinic at a tertiary-care referral hospital.
  
  
  METHODS
  Children with GFR between 15-60 mL/min/1.73 m2 were randomized to receive either enalapril at 0.4 mg/kg /day or no enalapril for 1 year.
  
  
  METHODS
  Change in GFR using 99mTc-DTPA and urine protein to creatinine ratio. Secondary outcomes included occurrence of composite outcome (30% decline in GFR or end stage renal disease) and systolic and diastolic blood pressure SDS during the study period.
  
  
  RESULTS
  41 children were randomized into two groups; 20 received enalapril while 21 did not receive enalapril. During 1 year, GFR decline was not different in the two groups (regression coefficient (r) 0.40, 95% CI -4.29 to 5.09, P=0.86). The mean proteinuria reduction was 65% in the enalapril group, significantly higher than control group. The difference was significant even after adjustment for blood pressure was 198.5 (CI 97.5, 299.3; P<0.001). 3 (17.6%) patients in enalapril and 7 (36.8%) in non-enalapril group attained the composite outcome.
  
  
  CONCLUSIONS
  Enalapril is effective in reducing proteinuria in children with CKD and might be renoprotective in proteinuric CKD.
authors.affiliation: Departments of Pediatrics, *Biostatistics and #Nuclear Medicine, All India Institute of Medical Sciences, Ansari Nagar, New Delhi, India. Correspondence to: Dr Pankaj Hari, Professor, Department of Pediatrics, All India Institute of Medical Sciences, Ansari Nagar, New Delhi 110 029, India. pankajhari@hotmail.com.
authors.forename: Pankaj
authors.initials: P
authors.lastname: Hari
authors.forename: Jitender
authors.initials: J
authors.lastname: Sahu
authors.forename: Aditi
authors.initials: A
authors.lastname: Sinha
authors.forename: Ravinder Mohan
authors.initials: RM
authors.lastname: Pandey
authors.forename: Chandra Shekhar
authors.initials: CS
authors.lastname: Bal
authors.forename: Arvind
authors.initials: A
authors.lastname: Bagga
mesh_terms: D000293:Adolescent; D000959:Antihypertensive Agents / Q000627:therapeutic use*; D002648:Child; D002675:Child, Preschool; D004656:Enalapril / Q000627:therapeutic use*; D005260:Female; D005919:Glomerular Filtration Rate / Q000187:drug effects*; D006801:Humans; D008297:Male; D011446:Prospective Studies; D011507:Proteinuria / Q000188:drug therapy* / Q000503:physiopathology / Q000652:urine; D051436:Renal Insufficiency, Chronic / Q000188:drug therapy* / Q000503:physiopathology / Q000652:urine
chemical_list: D000959:Antihypertensive Agents; D004656:Enalapril