Delucchi A, Cano F, Rodriguez E, Wolff E, Gonzalez X, Cumsille M A
Division of Pediatric Nephrology, Hospital Luis Calvo Mackenná, Universidad de Chile, Santiago.
Pediatr Nephrol. 2000 Oct;14(12):1088-91. doi: 10.1007/s004679900244.
The effect of enalapril and low prednisone doses on the urinary protein electrophoretic pattern was studied in 13 pediatric patients with glomerular diseases and steroid-resistant nephrotic syndrome. Enalapril was administered at doses of 0.2-0.6 mg/kg per day for 24-84 months, and prednisone was introduced 2 months later in 11 patients at doses of 30 mg/m2 on alternate days. The urine protein electrophoretic pattern showed a reduction of 80% and 70% in the total protein and albumin, respectively, after enalapril. Total urinary protein decreased from 5.46 to 1.1 g/m2 per day (P<0.001). A marked change from a pattern of non-selective urinary protein loss to an albumin-selective proteinuria was observed. Mean total plasma proteins increased from 4.7 to 5.43 g/dl (P<0.001). Four patients became free of proteinuria 24 months after enalapril was started, but only 2 remained free of proteinuria at 48 months of follow-up. The other 11 patients had persistent albuminuria of between 0.5 and 2.6 g/m2 per day with a selective urinary electrophoretic pattern. No additional decrease was observed after steroids were introduced. A clinical improvement in edema was observed in all children. Three patients developed transient acute renal failure, during the course of an infectious disease; 2 developed peritonitis and 1 pneumopathy. In these patients withdrawal of enalapril was necessary until a complete recovery of renal function was observed. Four patients were hypertensive on admission, achieving normal blood pressure 1 month after enalapril was started. No episodes of systemic arterial hypotension were seen. Creatinine clearance and serum potassium showed no statistically significant change.
在13例患有肾小球疾病和类固醇抵抗性肾病综合征的儿科患者中，研究了依那普利和低剂量泼尼松对尿蛋白电泳图谱的影响。依那普利的给药剂量为每天0.2 - 0.6 mg/kg，持续24 - 84个月，11例患者在2个月后开始隔日服用泼尼松，剂量为30 mg/m²。服用依那普利后，尿蛋白电泳图谱显示总蛋白和白蛋白分别减少了80%和70%。每日尿总蛋白从5.46降至1.1 g/m²（P<0.001）。观察到从非选择性尿蛋白丢失模式显著转变为白蛋白选择性蛋白尿。平均总血浆蛋白从4.7增加到5.43 g/dl（P<0.001）。4例患者在开始服用依那普利24个月后蛋白尿消失，但在随访48个月时只有2例仍无蛋白尿。其他11例患者每日持续存在0.5至2.6 g/m²的白蛋白尿，伴有选择性尿电泳图谱。引入类固醇后未观察到进一步下降。所有儿童的水肿均有临床改善。3例患者在传染病过程中发生短暂性急性肾衰竭；2例发生腹膜炎，1例发生肺炎。在这些患者中，必须停用依那普利，直到肾功能完全恢复。4例患者入院时高血压，开始服用依那普利1个月后血压恢复正常。未观察到系统性动脉低血压发作。肌酐清除率和血清钾无统计学显著变化。
