Effect of enalapril in children with steroid resistant primary nephrotic syndrome
Keywords:
enalapril, proteinuria, steroid resistant, nephrotic syndrome
Abstract
Background A significant proportion of children with nephrotic syndrome become steroid dependent or steroid resistant who need further medication with cytostatic or other immunosuppressive drugs such as cyclophosphamide or chlorambucil. Unfortunately studies show that the drugs give no good results and cause adverse effects.Objective To establish the effect of enalapril in decreasing proteinuria in children with steroid resistant nephrotic syndrome.
Methods We conducted a clinical trial in Nephrology Division, Pediatrics Department, Dr. Sardjito General Hospital from January 2004 to October 2005. Subjects were randomized to either receive prednisone and enalapril (Enalapril Group) or prednisone and cyclophosphamide (CPA Group). The main parameter was proteinuria level, which was examined at the beginning of the study and then every two weeks for eight weeks.
Results Remission rate in enalapril group was 96% whereas in CPA group was 82% (P=0.09). Proteinuria level reduction in Enalapril Group from the beginning until the end was 606.92 mg/dl (99%) whereas in CPA Group the reduction was 712.97 mg/dl (91%). Statistically, there was no significant difference in the average decrease of proteinuria level between both groups (P=0.30). Odds ratio for overall adverse events in combined prednisone and enalapril therapy group compared to combined prednisone and cyclophosphamide therapy group was 0.29 (CI 95% 0.17;0.41).
Conclusion Combined prednisone and enalapril has similar effect to
combined prednisone and cyclophosphamide in children with steroid
resistant nephrotic syndrome. Overall adverse events in combined
prednisone and enalapril group was lower than that in combined
prednisone and cyclophosphamide group.
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tata laksana sindrom nefrotik idiopatik pada anak. Unit Kerja
Koordinasi Nefrologi Ikatan Dokter Anak Indonesia, 2005.
2. Haycock G. The child with idiopathic nephrotic syndrome.
In: Webb, NJA & Postlethwaite, RJ, editors. Clinical Paedi-
atric Nephrology. 3 rd ed. New York: Oxford University Press;
2003. p. 341-65.
3. Hodson EM, Knight JF, Willis, NS, Craig JC. Corticosteroid
therapy in nephrotic syndrome: a meta-analysis of
randomised controlled trial. Arch Dis Child 2000;83:45-51.
4. Damanik MP. Clinical features of nephrotic syndrome in
children. Paediatr Indones 1997;37:13-9.
5. Roth KS, Amaker BH, Chan, JCM. Nephrotic syndrome:
pathogenesis and management. Pediatrics in review 2002;
23:237-47.
6. Tarshish P, Tobin JN, Bernstein J, Edelmann CM. Cyclo-
phosphamide does not benefit patients with focal segmental
glomerulosclerosis. A report of the International Study of Kid-
ney Disease in Children. Pediatr Nephrol 1996;10:590-3.
7. Latta K, Schmakenburg CV, Ehrich JHH. A meta-analysis
of cytotoxic treatment for frequently relapsing nephrotic syndrome in children. Pediatr Nephrol 2001;16:271-82.
8. Balfe JW, Levin L, Radde IC. Hipertensi dan terapinya. In:
Masyrof M, editor. Farmakologi dan terapi pediatri. 2 nd edi-
tion. Jakarta: Hipokrates; 1999. p. 751-75.
9. Sasinka MA, Podracka L, Boor A, Jurkovic I, Mitro A, Kovacs
L. Enalapril treatment of proteinuria in normotensive chil-
dren. Bratisl Lek Listy 1999;100: 476-80.
10. Hogg RJ, Portmann RJ, Milliner D, Lemley KV, Eddy A,
Ingelfinger J. Evaluation and management of proteinuria dan
nephritic syndrome in children: recommendation from a
pediatric nephrology panel established at the National Kid-
ney Foundation Conference on proteinuria, albuminuria, risk,
assessment, detection and elimination (PARADE). Pediat-
rics 2000;105:1242-49.
11. Delucchi A, Cano F, Rodriguez E, Wolff E, Gonzalez X,
Cumsille MA. Enalapril and prednisone in children with
nephrotic-range proteinuria. Pediatr Nephrol 2000;14:
1088-91.
12. Wirya IGNW. Sindrom nefrotik. In: Buku ajar nefrologi anak.
2 nd edition. Jakarta: Balai Penerbit Fakultas Kedokteran UI;
2002. p. 381-422.
13. Lemeshow S, Hosmer DW, Klar J, Lwanga SK. Besar sampel
dalam penelitian kesehatan. Yogyakarta : Gadjah Mada Uni-
versity Press; 1997. p. 50-2.
Published
2007-05-01
How to Cite
1.
Atmikasari L, Damanik M, Sadjimin T. Effect of enalapril in children with steroid resistant primary nephrotic syndrome. PI [Internet]. 1May2007 [cited 5May2024];47(2):55-. Available from: https://www.paediatricaindonesiana.org/index.php/paediatrica-indonesiana/article/view/344
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Received 2016-08-25
Accepted 2016-08-25
Published 2007-05-01
Accepted 2016-08-25
Published 2007-05-01
