Litwin Mieczysław, Grenda Ryszard, Sladowska Joanna, Antoniewicz Jolanta
Department of Nephrology, Kidney Transplantation and Arterial Hypertension, The Children's Memorial Health Institute, Aleja Dzieci Polskich 20, 04736, Warsaw, Poland.
Pediatr Nephrol. 2006 Nov;21(11):1716-22. doi: 10.1007/s00467-006-0223-2. Epub 2006 Aug 15.
The standard renoprotection is based on the inhibition of the renin-angiotensin system (RAS) by angiotensin convertase inhibitors (ACEi) or angiotensin II receptor 1 blockers (AT1B). The aim of our study was to analyze the effects of the addition of AT1B to ACEi-based renoprotection in children with chronic kidney disease. We examined 11 children with a mean age of 10.5 years (range, 0.5-18 years) with a mean glomerular filtration rate (GFR) of 61+/-61 ml/min/1.73 m(2). In four patients, the primary renal disease was hemolytic uremic syndrome, in three congenital nephrotic syndrome (CNS), in two reflux nephropathy, prune-belly syndrome in one and acute cortical necrosis in one. All patients were treated with complex hypotensive ACEi-based therapy. AT1B losartan was added in a mean dose of 0.9 mg/kg/day. The change in GFR, proteinuria and blood pressure at two 12-month intervals before and after adding AT1B was compared. The results showed that during the 12 months preceding AT1B therapy, there was no change in blood pressure and proteinuria, but the GFR declined in 7 of 11 patients. After the 12th month of add-on therapy with AT1B, there was a significant decrease in both absolute and indexed blood pressure values. Proteinuria decreased in eight patients, did not change in one and increased in two, including one with CNS. The GFR stabilized or increased in eight patients and decreased in three patients with CNS. In 7 of 11 patients, there was a significant, but not threatening increase in serum potassium. In conclusion, add-on renoprotection with AT1B added to ACEi is safe and significantly improves the renoprotective effects of ACEi treatment in children with progressive nephropathies, including patients with advanced CKD.
标准的肾脏保护措施是通过血管紧张素转换酶抑制剂（ACEi）或血管紧张素II受体1阻滞剂（AT1B）抑制肾素-血管紧张素系统（RAS）。我们研究的目的是分析在以ACEi为基础的肾脏保护治疗中加用AT1B对慢性肾脏病患儿的影响。我们检查了11名平均年龄为10.5岁（范围0.5 - 18岁）、平均肾小球滤过率（GFR）为61±61 ml/min/1.73 m²的儿童。4例患者的原发性肾脏疾病为溶血尿毒综合征，3例为先天性肾病综合征（CNS），2例为反流性肾病，1例为梅干腹综合征，1例为急性皮质坏死。所有患者均接受了以ACEi为基础的复杂降压治疗。加用平均剂量为0.9 mg/kg/天的AT1B氯沙坦。比较了加用AT1B前后两个12个月期间GFR、蛋白尿和血压的变化。结果显示，在AT1B治疗前的12个月中，血压和蛋白尿无变化，但11例患者中有7例GFR下降。加用AT1B治疗12个月后，绝对血压值和指数血压值均显著下降。8例患者蛋白尿减少，1例无变化，2例增加，其中1例为CNS患者。8例患者GFR稳定或升高，3例CNS患者GFR下降。11例患者中有7例血清钾有显著但无危险的升高。总之，在ACEi基础上加用AT1B进行额外的肾脏保护是安全的，并且显著改善了ACEi治疗对进行性肾病患儿（包括晚期慢性肾脏病患者）的肾脏保护效果。
