Angiotensin blockade in children with chronic glomerulonephritis and heavy proteinuria

Abstract

Patients with chronic proteinuric nephropathies are at high risk of developing progressive renal insufficiency. There are limited controlled data on the efficacy of potentially toxic immunosuppressive therapies for many of these diseases such as immunoglobulin A nephropathy and idiopathic membranoproliferative glomerulonephritis. This limitation has not deterred healthcare providers from using such agents based on anecdotal experience. We report our experience taking care of three children with heavy proteinuria from chronic glomerular diseases. All were treated with a combination of angiotensin-converting enzyme inhibitors and angiotensin receptor blockers without concomitant immunosuppression. All went into complete remission soon after starting therapy, allowing corticosteroid avoidance. The purpose of this report is to make healthcare professionals more aware of the potential success that can be achieved with this relatively nontoxic drug regimen. Larger controlled clinical trials using this strategy are needed to better evaluate the efficacy and safety of this approach in children with glomerular diseases.

Angiotensin blockade as sole treatment for proteinuric kidney disease in children

“…Although these drugs have proven benefits in some glomerular disorders, they are fraught with significant toxicity. In recent years, efforts have been directed towards alternative and diseasespecific therapies [9][10]12]. Our observations in children treated with angiotensin blockade alone suggest that this may provide an effective alternative to aggressive steroid and immune modulating therapies in some glomerular diseases.…”

“…There are scant anecdotal reports in the literature about treatment of chronic glomerulonephritis with angiotensin blockade in children with normal renal function [10]. Most studies involve patients who are on concurrent immunosuppressive treatment, or have hypertension and renal insufficiency [9,11,14].…”

“…The addition of angiotensin blockade (AB) with either ACEI and/or ARB alone or in combination has been shown to further decrease proteinuria in children [9][10][11][12][13][14]. However, the independent effect of AB needs further elucidation.…”

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.…”