Angiotensin blockade as sole treatment for proteinuric kidney disease in children

Abstract

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 AE 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 AE 23% vs dual 71 AE 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 AE 41-111 AE 17 ml/min/1.73m 2 ; P ¼ 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.

Tetradecylthioacetic acid prevents the inflammatory response in two-kidney, one-clip hypertension

“…It is generally accepted that drugs that interfere with RAS, such as angiotensinconverting enzyme inhibitors and AT 1 -receptor (AT 1 R) blockers, reduce vascular and tubular inflammation in chronic kidney disease (11,13,37), but, in contrast to TTA, these drugs also lower the blood pressure in SHR. An important issue that needs to be explored is whether TTA has any effect on inflammation in hypertension.…”

Angiotensin Receptor Blocker Reduces Proteinuria Independently of Blood Pressure in Children Already Treated with Angiotensin-Converting Enzyme Inhibitors

“…Several interventional trials in adults have shown that dual blockade of the RAAS with ACEI and ARB possesses greater antiproteinuric and renoprotective effects than single blockade with an ACEI even at high doses [7][8]19] . However, in children, only few studies have investigated the efficacy of dual blockade of the RAAS on proteinuria, renal function, BP or cardiac structure with ACEI and ARB [9][10][11][12] . Butani [9] has reported on 3 children with chronic glomerulonephritis treated with a combination of ARB and ACEI without concomitant immunosuppression.…”

“…In children, there are only few studies investigating the efficacy of dual blockade of the RAAS with ACEI and ARB [9][10][11][12] . Therefore, the aim of our study was to investigate whether adding an ARB to proteinuric children already under ACEI treatment may further reduce proteinuria.…”

Proteinuria in Special Populations: Pregnant Women and Children

“…[51][52][53] Recent trials confirmed the short-term antiproteinuric efficacy of angiotensin receptor blockers in children from 1 year of age onward. 54, 55 The antiproteinuric response is drug dose-dependent 54 and appears to be quantitatively similar in children with glomerular and nonglomerular disorders.…”