Achieving Remission of Proteinuria in Childhood CKD #MMPMID27704256
Ruggenenti P; Cravedi P; Chianca A; Caruso M; Remuzzi G
Pediatr Nephrol 2017[Feb]; 32 (2): 321-30 PMID27704256show ga
Background: A multidrug treatment titrated to proteinuria by maximum tolerated doses of an angiotensin converting enzyme (ACE) inhibitor and an angiotensin receptor blocker (ARB) combined with intensified blood pressure (BP) control prevented renal function loss in adults with proteinuric nephropathies. Herein, we investigated the effects of this program in children. Methods: From May 2002 to September 2014 we included in this observational, longitudinal, cohort study twenty consecutive children with chronic nephropathies and 24-h proteinuria >200mg who received ramipril and losartan up-titrated to maximum approved doses (2.48±1.37 mg/m2 and0.61±0.46 mg/kg daily, respectively). The primary efficacy endpoint was more than 50% 24-h proteinuria reduction to <200 mg (Remission). Secondary outcomes included changes in proteinuria, serum albumin, BP, and glomerular filtration rate (GFR). Results: Mean (±SD) patient age at inclusion was 13.8±2.8 years, median (IQR) serum creatinine 0.7 (0.6-1.0) mg/dl and proteinuria 690 (379-1270) mg/24h [or 435 (252-711) mg/m2/24h]. Proteinuria significantly decreased by month six and serum albumin levels increased over a follow-up period of 78 (39-105) months. In the nine children who achieved remission, proteinuria reduction persisted throughout the whole follow-up without rebounds. GFR improved in the children with remission and worsened in those without. Mean±SD GFR slopes (+0.023±0.15 vs. -0.014±0.23 ml/min/1.73m2/month, respectively) significantly (p<0.05) differed, whereas BP control was similar between the two groups. We observed hyperkalemia in two children. Conclusions: Combination therapy with maximum approved doses of ACE inhibitors and ARBs may achieve proteinuria remission with kidney function stabilization or even improvement in a substantial proportion of children with proteinuric nephropathies, and is safe.
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Pediatr+Nephrol 2017 ; 32 (2): 321-30
