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Long-term therapy with enalapril in patients with nephrotic-range proteinuria
W Proesmans1, I V Wambeke, M V Dyck
1Department of Paediatrics, University Hospital, University of Leuven, Belgium.
Insights
Enalapril reduced proteinuria in most pediatric patients with nephrotic syndrome, but also caused a decline in glomerular filtration rates in all participants. Further research is needed to understand these effects.
Area of Science:
- Pediatric Nephrology
- Pharmacology
- Internal Medicine
Background:
- Nephrotic-range proteinuria in children presents significant challenges.
- Steroid-resistant nephrotic syndrome requires alternative treatment strategies.
- Angiotensin-converting enzyme inhibitors like enalapril are explored for renal protection.
Purpose of the Study:
- To evaluate the efficacy of enalapril in reducing proteinuria in pediatric patients with diverse renal diseases.
- To assess the impact of enalapril on renal function, specifically glomerular filtration rate (GFR).
Main Methods:
- A cohort of six pediatric patients with nephrotic-range proteinuria received enalapril.
- Treatment duration was 24 months, with varying dosages based on age.
- Urinary protein excretion and renal function (GFR) were monitored throughout the study.
Main Results:
- Enalapril demonstrated varied effects on proteinuria, with complete disappearance in two patients and reduction in three others.
- One patient with Alport syndrome showed no change in proteinuria.
- All patients experienced a decrease in GFR, notably pronounced in two individuals, potentially reflecting disease progression.
Conclusions:
- Enalapril may offer benefits in reducing proteinuria in select pediatric nephrotic conditions.
- The observed decline in GFR warrants careful monitoring and further investigation into its relationship with enalapril therapy and disease course.
Abstract:
The effect of enalapril on urinary protein excretion and renal function was studied in six paediatric patients with various renal diseases causing nephroticrange proteinuria. In three younger children (aged 7-9 years) with steroid-resistant nephrotic syndrome, enalapril at a dose of 0.5 mg/kg per day given for 24 months yielded a temporary reduction of proteinuria in one child, a moderate and steady decrease in another and a complete disappearance of proteinuria in the third. Three adolescents, aged 17 years, took enalapril for 24 months at a dose of 20 mg/day. We observed no effect on proteiuria in one patient with Alport syndrome, a complete disappearance of urinary protein in one patient with membranoproliferative glomerulonephritis and a moderate decrease in the third patient who had idiopathic steroid-resistant nephrotic syndrome. Enalapril therapy resulted in an important reduction of proteinuria in two patients and a moderate decrease in three others. However this therapy was accompanied by a fall in glomerular filtration in all subjects, which was very marked in two patients. This fall in glomerular filtration may, however, simply reflect the natural course of the disease.