Antiproteinuric effects of enalapril and losartan: a pilot study

Abstract

In this randomized double-blind crossover trial we compared the antiproteinuric effects of enalapril and losartan in six children with proteinuria and underlying renal injury. The primary endpoint was reduction in proteinuria during therapy. The study had two 8-week on-drug arms, with a 4-week washout period between. Baseline proteinuria was similar, enalapril 87 mg/m(2) per hour and losartan 77 mg/m(2) per hour. The mean reduction in proteinuria with enalapril was 48% (37%-57%) with a standard error of the mean of 3%; with losartan it was 31% (14%-52%) with a standard error of the mean of 7%. Although there was a significant reduction in proteinuria with the use of both drugs, the difference in reduction of proteinuria, 48% versus 31%, was not considered clinically significant. Potassium remained below 4.5 mmol/l in all patients. No patient's creatinine rose more than the standard deviation of our assay. Blood pressure (BP) control was acceptable in four of the six patients; two patients had persistently elevated or increased BP on each drug. Side effects were minimal; none requiring withdrawal, one requiring dose reduction. Studies have shown that angiotensin converting enzyme inhibitors can reduce proteinuria in children with renal disorders. No studies to date have examined the reduction of proteinuria achieved by angiotensin receptor blockers. Our study, although small, suggests that angiotensin receptor blockers may reduce proteinuria as effectively, and as safely, as angiotensin converting enzyme inhibitors.

Simultaneous Mutations in the CLCNKB and SLC12A3 Genes in Two Siblings with Phenotypic Heterogeneity in Classic Bartter Syndrome

“…In this regard, it is interesting to note that aldosterone level was normal and proteinuria was low (0.26 g/d) at the last clinical examination. On the other hand, the reduction in proteinuria may also be due to the long-term use of enalapril (30) as the sister presented persistently high levels of both renin and aldosterone, but no proteinuria was detected. In the light of these observations, the possible pathogenesis of FSGS in patients with Bartter syndrome needs further evaluation.…”

Evidence-based guidelines for the management of hypertension in children with chronic kidney disease

“…In the ESCA PE trial, intensified blood pressure control did slow disease progression in children with hypodysplasia, but the study was not designed to attribute the outcomes to ACE inhibitor use specifically [4]. A small randomized double blind cross-over trial in children with proteinuric renal disease demonstrated a similar reduction in proteinuria with ACE inhibitor compared with ARB, a finding that has been confirmed with a more recent larger trial [46,47]. Combined use of ACE inhibitors and ARBs has shown additional reduction in proteinuria with both agents in two small studies in children [48,49].…”

Effect of angiotensin-converting enzyme gene insertion/deletion polymorphism on steroid resistance in Egyptian children with idiopathic nephrotic syndrome

“…3 It is, however, difficult to predict the course of the disease in terms of steroid responsiveness or steroid resistance. 4 ACE inhibitors and angiotensin receptor blockers reduce proteinuria in patients with nephrotic syndrome, 5 stressing the role of the RAAS in the pathogenesis of nephritic syndrome. A polymorphism of the ACE gene, consisting of a 287-base pair fragment within intron 16 defined by insertion (I) or deletion (D), has been shown to influence the circulating and cellular ACE concentration.…”