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Achieving remission of proteinuria in childhood CKD
#MMPMID27704256
Ruggenenti P
; Cravedi P
; Chianca A
; Caruso M
; Remuzzi G
Pediatr Nephrol
2017[Feb]; 32
(2
): 321-330
PMID27704256
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BACKGROUND: A multidrug treatment strategy that targets urinary proteins with an
angiotensin-converting enzyme (ACE) inhibitor and angiotensin receptor blocker
(ARB) up-titrated to the respective maximum tolerated dose combined with
intensified blood pressure (BP) control has been found to prevent renal function
loss in adults with proteinuric nephropathies. Herein, we investigated the
effects of this treatment protocol in the pediatric patient population. METHODS:
From May 2002 to September 2014 we included in this observational, longitudinal,
cohort study 20 consecutive children with chronic nephropathies and 24-h
proteinuria of >200 mg who had received ramipril and losartan up-titrated to the
respective maximum approved and tolerated doses [mean (?standard deviation)
dose:2.48?(1.37) mg/m(2) and 0.61 (0.46) mg/kg daily, respectively]. The primary
efficacy endpoint was a >50 % reduction in 24-h proteinuria to <200 mg
(remission). Secondary outcomes included changes in proteinuria, serum albumin,
BP, and glomerular filtration rate (GFR). RESULTS: Mean (± standard deviation)
patient age at inclusion was 13.8?±?2.8 years, and the median [interquartile
range (IQR)] serum creatinine level and proteinuria were 0.7 (0.6-1.0) mg/dl and
690 (379-1270) mg/24 h or 435 (252-711) mg/m(2)/24 h, respectively. Proteinuria
significantly decreased by month 6 of follow-up, and serum albumin levels
increased over a median follow-up period of 78 (IQR 39-105) months. In the nine
children who achieved remission, proteinuria reduction persisted throughout the
whole follow-up without rebounds. The GFR improved in those children who achieved
remission and worsened in those who did not. The mean GFR slopes differed
significantly between these two groups (p?
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