Chan Eugene Yu-Hin, Ma Alison Lap-Tak, Tullus Kjell
Department of Paediatric Nephrology, Great Ormond Street Hospital for Children NHS Trust, London, UK.
Paediatric Nephrology Centre, Hong Kong Children's Hospital, Ngau Tau Kok, Hong Kong.
Pediatr Nephrol. 2021 Jul;36(7):1751-1764. doi: 10.1007/s00467-020-04788-w. Epub 2020 Oct 14.
Renin-angiotensin-aldosterone inhibitors (RAASi) are the mainstay therapy in both adult and paediatric chronic kidney disease (CKD). RAASi slow down the progression of kidney failure by optimization of blood pressure and reduction of proteinuria. Despite recommendations from published guidelines in adults, the evidence related to the use of RAASi is surprisingly scarce in children. Moreover, their role in advanced CKD remains controversial. Without much guidance from the literature, paediatric nephrologists may discontinue RAASi in patients with advanced CKD due to apparent worsening of kidney function, hyperkalaemia and hypotension. Current data suggest that this strategy may in fact lead to a more rapid decline in kidney function. The optimal approach in this clinical scenario is still not well defined and there are varying practices worldwide. We will in this review describe the existing evidence on the use of RAASi in CKD with particular focus on paediatric data. We will also address the use of RAASi in advanced CKD and discuss the potential benefits and harms. At the end, we will suggest a practical approach for the use of RAASi in children with CKD based on current state of knowledge.
肾素-血管紧张素-醛固酮抑制剂（RAASi）是成人和儿童慢性肾脏病（CKD）的主要治疗方法。RAASi通过优化血压和减少蛋白尿来减缓肾衰竭的进展。尽管成人已发布的指南有相关推荐，但儿童使用RAASi的证据却出奇地少。此外，它们在晚期CKD中的作用仍存在争议。由于缺乏文献的充分指导，儿科肾病学家可能会因肾功能明显恶化、高钾血症和低血压而停用晚期CKD患者的RAASi。目前的数据表明，这种策略实际上可能导致肾功能更快下降。这种临床情况下的最佳方法仍未明确界定，世界各地的做法也各不相同。在本综述中，我们将描述关于CKD中使用RAASi的现有证据，特别关注儿科数据。我们还将讨论RAASi在晚期CKD中的使用，并探讨潜在的益处和危害。最后，我们将根据当前的知识状况，为CKD儿童使用RAASi提出一种实用的方法。
