ACE inhibition in the treatment of children after renal transplantation

Arbeiter, Klaus; Pichler, Andrea; Stemberger, Regina; Mueller, Thomas; Ruffingshofer, Dagmar; Balzar, E; Aufricht, Christoph

doi:10.1007/s00467-003-1317-8

Cited by 29 publications

(29 citation statements)

References 13 publications

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“…The etiology of these complications remains uncertain, but multiple etiological factors, including cyclosporine, steroids, native or recurrent kidney disease, rejection, and renal artery stenosis of the transplanted kidney, may play a role in patients with renal transplants [12]. The relative refractoriness to therapy in our population was evidenced by the use of multiple antihypertensive medications; most of our patients were on two or more antihypertensives at the time of assessment.…”

Section: Discussionmentioning

confidence: 93%

Changes of blood pressure and left ventricular mass in pediatric renal transplantation

et al. 2004

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Cardiovascular events are among the most frequent causes for long-term morbidity and mortality in children after renal transplantation. The aim of this study was to analyze the effects of post-transplant changes in arterial hypertension, as assessed by 24-h ambulatory blood pressure measurement (ABPM), on myocardial architecture, as assessed by echocardiography. In a retrospective chart review analysis, 39 children were identified in whom 24-h ABPM and echocardiography had been assessed within a 3-month interval after a mean of 4 years post transplantation; 20 repeated pairs of measurements after a mean of 2 years of follow-up were available to analyze the longitudinal effects of post-transplant changes of blood pressure control on left ventricular mass index (LVMI). Arterial hypertension (59%) and left ventricular hypertrophy (50%) were highly prevalent in children after renal transplantation. Renal allograft function and number of antihypertensive medications, but not ABPM variables, were correlated with LVMI at the initial observation. However, at repeat assessment, a significant correlation between ABPM and LVMI was found. In the longitudinal assessment, left ventricular remodeling was dependent on change of dosage of cyclosporine and interval changes of blood pressure levels. Hence, control of blood pressure correlates with changes of LVMI in children with renal allografts. These results clearly underline the importance of blood pressure control for the maintenance of the myocardial architecture.

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Section: Discussionmentioning

confidence: 93%

Changes of blood pressure and left ventricular mass in pediatric renal transplantation

et al. 2004

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“…However, smallscale retrospective studies indicated that a decrease of proteinuria and a retardation of the progression of renal failure can be achieved by ACEI in children with chronic renal failure due to reflux nephropathy [23] or Alport syndrome [24,25], or after renal transplantation [26]. ARB have also been shown to reduce proteinuria in children [27,28].…”

Section: Clinical Trials: Acei and Arb And The Progression Of Kidney mentioning

confidence: 98%

Treatment strategies in patients with chronic renal disease: ACE inhibitors, angiotensin receptor antagonists, or both?

Hilgers

Dötsch²,

Rascher

et al. 2004

Pediatr Nephrol

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We discuss the evidence supporting the use of angiotensin-converting enzyme inhibitors (ACEI), angiotensin II type 1 receptor blockers (ARB), or the combination of both in children with chronic renal disease. Several large-scale, prospective, randomized studies with clinical end points have been performed in adult patients, but studies in children are relatively scarce. In adult patients with chronic renal diseases, ACEI clearly delay the progression of chronic non-diabetic renal diseases, and nephropathy in patients with type 1 diabetes. The benefits of ACEI are most apparent in glomerular diseases with marked proteinuria but extend also to kidney diseases with lower proteinuria. This notion is also supported by several smaller or retrospective trials in children. Therefore, ACEI should be given to children with chronic renal diseases, particularly if high blood pressure and/or proteinuria are present. In adults, large-scale trials have documented that ARB exert similar effects as ACEI but tend to exert fewer undesired side effects. Data on ARB in children with chronic renal disease are still very scarce, but these substances offer an alternative for patients who cannot tolerate ACEI due to unwarranted side effects. Combination therapy with ARB plus ACEI may be more effective than either drug class alone. However, we will need the results of further long-term prospective clinical studies, as well as a better understanding of the role of the AT(2) receptor, before combination therapy can be widely recommended. A trial of ARB plus ACEI is justified in selected patients if blood pressure and/or proteinuria cannot adequately be lowered by ACEI or ARB alone.

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“…Symptomatic non-specific antiproteinuric treatment with ACEIs/ARBs Angiotensin-converting enzyme inhibitors and angiotensin receptor blockers (ARBs) can decrease proteinuria not only in adults but also in pediatric renal transplant recipients [60,61]. Ramipril reduces proteinuria in nearly all proteinuric children even without influencing the BP [61].…”

Section: Causal Treatmentmentioning

confidence: 99%

Management of proteinuria in the transplanted patient

Seeman

2014

Pediatr Nephrol

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Proteinuria is a relatively frequent complication in children after renal transplantation (40-80 %). It is usually mild and non-nephrotic in nature and predominantly tubular in origin. The major causes of post-transplant proteinuria are recurrence of primary glomerulonephritis [mostly focal segmental glomerulosclerosis (FSGS)], rejection (acute and chronic), mTOR inhibitors or hypertension. Proteinuria is a risk factor for graft loss and patient death in adults, and even a mild proteinuria (0.1-0.2 g/day) is associated with impaired graft and patient survival. In children, proteinuria seems to be associated with graft but not patient survival. Proteinuria (protein/creatinine ratio) should be assessed regularly in all children. In children with prior chronic kidney disease due to idiopathic FSGS, proteinuria should be assessed daily during the first month after transplantation to enable early diagnosis of recurrence. The cause of proteinuria should be identified, and graft biopsy should be considered in children with unexplained proteinuria, especially with new onset proteinuria or deterioration of previously mild proteinuria. Treatment must be primarily targeted at the cause of proteinuria, and in normotensive children symptomatic antiproteinuric therapy with angiotensinconverting enzyme inhibitors/angiotensin II receptor antagonists should also be initiated. Other antihypertensive drugs should be used to achieve target blood pressure of<75th percentile. Target proteinuria should be <20 mg/mmol creatinine.

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ACE inhibition in the treatment of children after renal transplantation

Cited by 29 publications

References 13 publications

Changes of blood pressure and left ventricular mass in pediatric renal transplantation

Changes of blood pressure and left ventricular mass in pediatric renal transplantation

Treatment strategies in patients with chronic renal disease: ACE inhibitors, angiotensin receptor antagonists, or both?

Management of proteinuria in the transplanted patient

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