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Pediatric Nephrology
Published in: Pediatric Nephrology 5/2013

01-05-2013 | Original Article

Additive antiproteinuric effect of enalapril and losartan in children with hemolytic uremic syndrome

Authors: María Gracia Caletti, Alejandro Balestracci, Mabel Missoni, Clarisa Vezzani

Published in: Pediatric Nephrology | Issue 5/2013

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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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Metadata
Title
Additive antiproteinuric effect of enalapril and losartan in children with hemolytic uremic syndrome
Authors
María Gracia Caletti
Alejandro Balestracci
Mabel Missoni
Clarisa Vezzani
Publication date
01-05-2013
Publisher
Springer-Verlag
Published in
Pediatric Nephrology / Issue 5/2013
Print ISSN: 0931-041X
Electronic ISSN: 1432-198X
DOI
https://doi.org/10.1007/s00467-012-2374-7

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