Related Experiment Videos
Enalapril treatment of proteinuria in normotensive children
M A Sasinka1, L Podracka, A Boor
1Department of Pediatrics, Medical School, Safarikiensis University, Kosice, Slovakia. nefrol@kosice.upjs.sk
Insights
Enalapril effectively reduces proteinuria in children, with or without prednisone. This treatment is safe and does not affect blood pressure, offering a valuable option for managing protein loss in children with normal blood pressure.
Area of Science:
- Pediatric Nephrology
- Pharmacology
- Clinical Medicine
Background:
- Proteinuria in children can indicate underlying kidney issues.
- Symptomatic treatment aims to reduce protein loss and prevent complications.
- Normotensive children with preserved renal function present a specific treatment challenge.
Purpose of the Study:
- To evaluate the efficacy of enalapril and prednisone in reducing proteinuria in children.
- To compare the effects of enalapril alone, prednisone alone, and combination therapy.
- To assess the impact of these treatments on systemic blood pressure.
Main Methods:
- Retrospective study of 48 children with normotensive proteinuria.
- Treatment groups: enalapril (n=17), enalapril + prednisone (n=11), prednisone alone (n=20).
- Urinary protein excretion and systemic blood pressure were monitored over 8 weeks.
Main Results:
- Enalapril significantly reduced proteinuria within 4 weeks, an effect sustained at 8 weeks.
- Combination therapy showed comparable proteinuria reduction to enalapril alone.
- Prednisone alone resulted in a slower, significant reduction in proteinuria starting at week 6.
- Enalapril's antiproteinuric effect was independent of blood pressure changes.
Conclusions:
- Enalapril is safe and effective for symptomatic proteinuria treatment in normotensive children.
- ACE inhibitors like enalapril enhance corticosteroid therapy by accelerating proteinuria reduction.
- Combination therapy may be beneficial when hypoproteinemia is a concern.
Abstract:
A retrospective study was performed in 48 normotensive proteinuric children to evaluate the effect of enalapril (n = 17), a combination of enalapril and prednisone (n = 11) and prednisone alone (n = 20) on urinary protein excretion and systemic blood pressure. Enalapril treatment was associated with significant and persistent diminution of proteinuria from 1.32 +/- 0.23 to 0.53 +/- 0.11 and 0.44 +/- 0.07 g/day on the 4th and 8th week of treatment, respectively. Combined therapy with enalapril and prednisone resulted in a comparable significant reduction of proteinuria from a pre-treatment value of 2.06 +/- 0.42 to 0.63 +/- 0.22 and 0.52 +/- 0.17 g/day on the 4th and 8th week of treatment, respectively. In contrast to this, in the group treated with prednisone alone, proteinuria decreased significantly only from the 6th week of therapy (p < 0.02). Consequently, these children had significantly higher urinary protein losses at the 4th week of treatment as compared to patients on enalapril treatment (given either alone or combined with prednisone) (p < 0.01 and p < 0.05, respectively). Importantly, the enalapril-induced reduction of proteinuria was unrelated to variations in arterial blood pressure and no significant changes in this parameter were observed. The results indicate that enalapril can be used safety and effectively for symptomatic treatment of proteinuria in normotensive children with preserved renal function. ACE inhibitor provides additive antiproteinuric effect to corticosteroids by accelerating the rate of diminution of proteinuria. Its combination with prednisone may be of particular importance in those cases, where the degree of hypoproteinemia is a concern. (Tab. 2, Fig. 1, Ref. 29.)