Enalapril and prednisone in children with nephrotic-range proteinuria

Abstract

The effect of enalapril and low prednisone doses on the urinary protein electrophoretic pattern was studied in 13 pediatric patients with glomerular diseases and steroid-resistant nephrotic syndrome. Enalapril was administered at doses of 0.2-0.6 mg/kg per day for 24-84 months, and prednisone was introduced 2 months later in 11 patients at doses of 30 mg/m2 on alternate days. The urine protein electrophoretic pattern showed a reduction of 80% and 70% in the total protein and albumin, respectively, after enalapril. Total urinary protein decreased from 5.46 to 1.1 g/m2 per day (P<0.001). A marked change from a pattern of non-selective urinary protein loss to an albumin-selective proteinuria was observed. Mean total plasma proteins increased from 4.7 to 5.43 g/dl (P<0.001). Four patients became free of proteinuria 24 months after enalapril was started, but only 2 remained free of proteinuria at 48 months of follow-up. The other 11 patients had persistent albuminuria of between 0.5 and 2.6 g/m2 per day with a selective urinary electrophoretic pattern. No additional decrease was observed after steroids were introduced. A clinical improvement in edema was observed in all children. Three patients developed transient acute renal failure, during the course of an infectious disease; 2 developed peritonitis and 1 pneumopathy. In these patients withdrawal of enalapril was necessary until a complete recovery of renal function was observed. Four patients were hypertensive on admission, achieving normal blood pressure 1 month after enalapril was started. No episodes of systemic arterial hypotension were seen. Creatinine clearance and serum potassium showed no statistically significant change.

Progression of chronic renal failure in children with dysplastic kidneys

“…There are, however, reported case series in children with different diagnoses where ACE inhibitors have been used. In diabetic patients, it decreased albuminuria during 3 months [19], and in steroid-resistant nephrotic syndrome, treatment gave an important decrease in proteinuria [20][21][22][23]. Children treated with ACE inhibitors after previous haemolytic uremic syndrome with 8-15 years of follow-up showed stable renal function and minimal proteinuria in all five patients [24].…”

Síndrome hemolítico urémico en Chile: presentación clínica, evolución y factores pronósticos

“…Publicaciones recientes demuestran que los pacientes que presentaron SHU evolucionaron con microalbuminuria en su seguimiento en relación a pacientes normales [26][27][28] . En ellos, la utilización de medicamentos como los inhibidores de la enzima convertidora de angiotensina o asociados a los bloqueadores de los receptores AT1 de angiotensina II han disminuido la progresión del daño renal no inmunológico 29,30 .…”

Renin–angiotensin–aldosterone system inhibitors in pediatric focal segmental glomerulosclerosis

“…Finding effective treatment is therefore imperative, yet current therapeutic regimens, such as the International Study of Kidney Disease in Children (ISKDC) regimen and the Mendoza protocol, are suboptimal in children with primary FSGS because of poor response rates and significant toxicities [4]. The evidence supporting the use of other immunosuppressive therapies, such as mycophenolate, azathioprine, cyclosporine, or tacrolimus, is derived from isolated cases or small cohort studies [5][6][7].…”

“…Adjunctive renoprotective therapy with renin-angiotensin-aldosterone (RAAS) inhibition is well-established in various proteinuric diseases in both adults and children [6,8]. There is scant but noteworthy evidence that RAAS inhibition may be used as monotherapy.…”