Monday, March 8, 2010

ARB Use in Children for Proteinuria

So, how do we treat children with proteinuric renal disease? Angiotensin-converting enzyme (ACE) inhibitor or angiotensin receptor blocker (ARB) therapy? Maybe... but where is the data? Until now, no large, randomized, double-blind trials in children with proteinuria treated with ACE inhibitors or ARBs have previously been reported. Enter a new study published in the latest issue of the Clinical Journal of the American Society of Nephrology.

This study lasted 12-week, it was a double-blind, multinational study that investigated the effects of losartan 0.7 to 1.4 mg/kg per day compared with placebo (normotensive stratum) or amlodipine 0.1 to 0.2 mg/kg per day up to 5 mg/d (hypertensive stratum) on proteinuria (morning-void urinary protein-creatinine ratio, baseline ≥0.3 g/g) in 306 children up to 17 years of age. At twelve weeks of treatment with losartan significantly reduced proteinuria compared with amlodipine/placebo: losartan –35.8% (95% confidence interval: –27.6% to –43.1%) versus amlodipine/placebo 1.4% (95% confidence interval: –10.3% to 14.5%), P ≤ 0.001.  Adverse event incidence was low and comparable in all groups.

Conclusions: Losartan significantly lowered proteinuria and was well tolerated after 12 weeks in children aged 1 to 17 years with proteinuria with or without hypertension, a population that has not previously been rigorously studied.

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