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Angiotensin blockade as sole treatment for proteinuric kidney disease in children
Jayanthi Chandar1, Carolyn Abitbol, Brenda Montané
1Department of Pediatrics, Division of Paediatric Nephrology, University of Miami/Holtz Children's Hospital, P.O. Box 016960 (M-714), Miami, Florida 33101, USA. jchanda2@med.miami.edu
Insights
Angiotensin blockade alone effectively reduced proteinuria and stabilized kidney function in children with proteinuric kidney disease, offering a potential alternative to steroids, especially for those with obesity.
Area of Science:
- Pediatric Nephrology
- Glomerular Disorders
- Renal Disease Management
Background:
- Traditional management of pediatric proteinuric kidney disease often involves high-dose steroids, irrespective of comorbidities like obesity.
- This study investigates angiotensin blockade (AB) as a sole therapeutic strategy for children with non-diabetic proteinuric kidney disease.
Purpose of the Study:
- To evaluate the efficacy of angiotensin blockade (AB) as monotherapy in managing proteinuria in children.
- To assess the impact of AB on kidney function and blood pressure in this pediatric population.
Main Methods:
- Retrospective analysis of 146 children's charts.
- Identified 17 children treated exclusively with ACE inhibitors and/or ARBs for proteinuria.
- Assessed proteinuria, albuminuria, eGFR, potassium, and blood pressure at baseline and 3-month intervals for over 24 months.
Main Results:
- Significant reduction in proteinuria and albuminuria observed within 3-6 months of AB therapy, with further decreases over time (P<0.001).
- Dual AB therapy showed greater efficacy in reducing albuminuria compared to single therapy (71% vs 57%, P<0.02).
- Estimated GFR normalized from hyperfiltration levels, and blood pressure remained stable throughout the study.
Conclusions:
- Angiotensin blockade monotherapy effectively controls proteinuria and stabilizes renal function in children.
- This approach presents a viable alternative to potentially toxic treatments like corticosteroids, particularly for children with glomerular disorders and obesity.
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+/-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+/-23% vs dual 71+/-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+/-41-111+/-17 ml/min/1.73 m2; P=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.
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