Efficacy and safety of lisinopril for mild childhood IgA nephropathy: a pilot study

Abstract

Even in children with mild immunoglobulin (Ig)A nephropathy (IgA-N) showing minimal/focal mesangial proliferation, persistent proteinuria seems to be a risk factor for progression of the disease, indicating the need for an effective and safe treatment even in such cases. Studies carried out to date have indicated that angiotensin-converting enzyme inhibitors (ACEIs) reduce urinary protein excretion and preserve renal function in adult IgA-N. However, no prospective study of ACEI only for childhood IgA-N has yet been carried out. In this prospective single-arm pilot trial, we administered lisinopril (0.4 mg/kg per day) as therapeutic treatment to 40 children with mild IgA-N with proteinuria [morning urinary protein/creatinine ratio (uP/Cr) >or= 0.2 g/g]. Thirty-three patients reached the primary endpoint (uP/Cr < 0.2) during the 2-year treatment period. The cumulative disappearance rate of proteinuria determined by the Kaplan-Meier method was 80.9%. Mean uP excretion was reduced from 0.40 to 0.18 g/m(2)/day (p < 0.0001). Of the 40 patients treated, five (12.5%) showed dizziness, and four of these five needed the lisinopril dose reduced. However, lisinopril therapy was continued in all patients during the 2-year treatment period. No other side effect, such as cough, was observed. We conclude that the efficacy and safety of lisinopril is seemingly acceptable for the treatment of children with mild IgA-N.

Validity of the Oxford classification of IgA nephropathy in children

“…ACEIs/ARBs [12] and long-term corticosteroid/combination therapies [11,[13][14][15][16] for IgAN have been used in Japanese children since the beginning of the 1990s [10,11]. In the pediatric area, ACEIs have been used for children with mild IgAN showing focal (≤80%) mesangial proliferation [10,12] and steroids or combination therapies are used for children with severe IgAN showing diffuse (>80%) mesangial proliferation [10,11,[13][14][15][16].…”

“…In this study, we retrospectively investigated clinical records from 161 consecutive children newly diagnosed as having IgAN between May 1977 and December 1989. The reason why we selected this period was that ACEIs/ARBs [12] and long-term corticosteroid/combination therapies [11,[13][14][15][16] for IgAN have been used in Japanese children since the beginning of the 1990s [10,11]. We wished to assess the validity of the Oxford classification in the cohort with as little effect on treatment as possible.…”

Long-Term Results of a Randomized Controlled Trial in Childhood IgA Nephropathy

“…On the basis of the short-term outcome of this RCT, more patients received the combination therapy in the control therapy group than in the combination therapy group. On the other hand, because the use of ACEIs, which was restricted in the initial 2-year study period, has become clearly effective even in childhood IgA nephropathy (31), there was a tendency toward using it more often in the combination therapy group than in the control group. This may have affected the long-term outcome in this study.…”

A Cost-effectiveness Analysis of Screening Urine Dipsticks in Well-Child Care

“…Pediatric studies are just starting to emerge. [12][13][14][15][16] Alternatively, a targeted screen for children at high risk may be cost-effective, as suggested for adults. 12 This analysis was limited by several factors.…”