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Angiotensin Blockade Alone Decreases Albuminuria in Children with Proteinuric Kidney Disease: Presented at ASN

By Maria Bishop

PHILADELPHIA, PA -- November 17, 2005 -- Angiotensin blockade alone results in a significant albuminuria decrease in children with proteinuric kidney disease, researchers reported here at the 38^th Annual Meeting and Scientific Exposition of the American Society of Nephrology (ASN).

The decrease in total proteinuria through angiotensin blockade alone suggests that there is also a decrease in tubular proteinuria, noted Jayanthi Chandar, MD, Associate Professor, Division of Pediatric Nephrology, University of Miami, Miami, Florida, United States.

Dr. Chandar presented the findings on November 12^th.

Dr. Chandar and colleagues conducted a chart analysis involving 145 children ages 2 to 18 years who were diagnosed with glomerular disease and/or proteinuria from January 2001 to June 2004.

In the cohort, 15 children were identified as having received exclusive angiotensin-converting enzyme (ACE) inhibitor or angiotensin receptor blocker (ARB) therapy. Eight patients received ARB monotherapy, one received ACE-inhibitor monotherapy, and six received ACE/ARB combination therapy.

The drugs used were enalapril 0.25 to 0.5 mg/kg/day, candesartan 0.2 to 0.4 mg/kg/day and losartan 0.4 to 1 mg/kg/day.

Children who were on concurrent immune suppressive therapy were excluded from the analysis.

Proteinuria was defined as urine protein/creatinine ratio >0.2 mg/mg and microalbuminuria was defined as microalbumin/creatinine ratio >30 mcg/mg, and were measured at varying intervals.

There was a significant decline in albuminuria and total proteinuria after 3 to 6 months of ACE inhibitor/ARB therapy in all of these patients, with a progressive decline coinciding with longer duration of treatment (P < .05).

Because the cohort was small, Dr. Chandar added, differences between ACE/ARB combination therapy and monotherapy may have existed but were not apparent.

At 24 to 30 months, there was a trend toward decrease in glomerular filtration rate estimated by the Schwartz formula. This could be explained on the basis of decreased hyperfiltration, Dr. Chandar noted.

The mean age of the children at baseline was 10.7 years, and 11 were female. The cohort included eight African-Americans, six Hispanics and one Caucasian.

At the end of the study, five patients were diagnosed with mesangial proliferative glomerulonephritis; four with familial focal segmental glomerulosclerosis; three with membranous glomerulosclerosis; and one had Alport's Syndrome. A final patient experienced "minimal change".

The long-term effect of angiotensin blockade on kidney function in children with proteinuric kidney disease remains to be determined, Dr. Chandar said. He noted that long-term follow-up will determine whether angiotensin blockade alone can preserve kidney function.

ACE inhibitors and ARBs are being used increasingly for management of proteinuria and are considered to be renoprotective.

Dr. Chandar receives research support from the Kidney Foundation of South Florida.


[Presentation title: Is Angiotensin Blockade Alone Effective in Proteinuric Kidney Disease? Abstract 1038]

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