ESPN 51th Annual Meeting

ESPN 2018


 
Comparison of the antiproteinuric effect of ACEI and ACEI plus ARB in children with proteinuric glomerular disease
MERAL TORUN BAYRAM 1 SEVCAN İMAM 1 ALPER SOYLU 1 SALIH KAVUKÇU 1

1- DOKUZ EYLÜL UNIVERSITY MEDICAL FACULTY DEPARTMENT OF PEDIATRICS
 
Introduction:

Dual blockade of the renin-angiotensin system with angiotensin-converting enzyme inhibitors (ACEI) and angiotensin receptor blockers (ARB) has higher anti-proteinuric effects than single blockade in adults. However, the little is known on dual blockade of the renin-angiotensin system in children. We investigated whether adding an ARB to proteinuric children already on ACEI reduces proteinuria.

Material and methods:

Hospital files of the 25 children with glomerular disease using ACEI and ARB plus ACEI were retrospectively evaluated. The patients were grouped as those only receiving ACEI (Group 1) and those receiving ACEI plus ARB (Group 2). Adding ARB to ACEI is usually due to insufficient response to ACEI alone. The patients in Group 1 and 2 were compared for age, proteinuria level and glomerular filtration rate (GFR) at the beginning and at last visit. In group 2, proteinuria levels and GFR were also assessed before and after treatment with ACEI alone.

Results:

There were no difference in mean age, proteinuria level and GFR at the beginning of treatment and at last visit between the two groups. In Group 1, mean proteinuria decreased from 92.4±75.2 mg/m2/h to 25.17±48.86 mg/m2/h after ACEI treatment (p=0.010). However, proteinuria level did not decrease in Group 2 (59.06±41.04 vs 65.90±63.81, p=0.785) when using ACEI alone. Addition of ARB to ACEI did not result in decrease in proteinuria level in Group 2 (78.0±78.5 vs 77.9±89.8, p=0.996) .

Conclusions:

In children with proteinuric glomerular disease unresponsive to ACEI, addition of an ARB does not reduce proteinuria.