Additive antiproteinuric effect of enalapril and losartan in children with hemolytic uremic syndrome |
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Authors: | María Gracia Caletti Alejandro Balestracci Mabel Missoni Clarisa Vezzani |
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Affiliation: | 1. Department of Nephrology, Hospital de Pediatría Prof. Dr. Juan P. Garrahan, Combate de los Pozos 1881, 1245, Buenos Aires, Argentina 3. Servicio de Nefrología, Hospital de Pediatría Prof. Dr. Juan P. Garrahan, Combate de Los Pozos 1881, CP 1245, Buenos Aires, Argentina 2. Department of Nutrition, Hospital de Pediatria Prof. Dr. Juan P. Garrahan, Combate de los Pozos 1881, Buenos Aires, Argentina
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Abstract: | Background Angiotensin-converting enzyme inhibitors or angiotensin II type 1 receptor blockers decrease postdiarrheal hemolytic uremic syndrome (D + HUS) sequelar proteinuria. However, proteinuria may persist in some patients. In nephropathies other than D + HUS, an additive antiproteinuric effect with coadministration of both drugs has been observed. Methods To assess such an effect in D + HUS, 17 proteinuric children were retrospectively studied. After a median period of 1 year post-acute stage (range 0.5–1.9) patients received enalapril alone for a median of 2.6 years (range 0.33–12.0) at a median dose of 0.4 mg/kg/day (range 0.2–0.56). As proteinuria persisted, losartan was added at a median dose of 1.0 mg/kg/day (range 0.5–1.5) during 2.1 years (range 0.5–5.0). Results The decrease in proteinuria with enalapril was 58.0 %, which was further reduced to 83.8 % from the initial value after losartan introduction. The percentage of reduction was significantly greater with the association of both drugs (p?=?0.0006) compared with the effect of enalapril exclusively (p?=?0.023). Serum potassium, glomerular filtration rate, and blood pressure remained unchanged. Conclusions Our results suggest that adding losartan to persisting proteinuric D + HUS children already on enalapril is safe and reduces proteinuria more effectively. Whereas this effect is associated with long-term kidney protection, it should be determined by prospective controlled studies. |
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