Pediatric Nephrology

, Volume 19, Issue 1, pp 45–50 | Cite as

Enalapril dosage in steroid-resistant nephrotic syndrome

  • Arvind Bagga
  • Basanagoud D. Mudigoudar
  • Pankaj Hari
  • Vandita Vasudev
Original Article


We have examined, in a randomized crossover trial, the antiproteinuric effect of treatment with low- (0.2 mg/kg daily) and high-dose (0.6 mg/kg daily) enalapril in 25 consecutive patients with steroid-resistant nephrotic syndrome (SRNS). Patients in group A (n=11) received enalapril at low doses for 8 weeks, followed by 2 weeks of washout and then at high doses for 8 weeks. Those in group B (n=14) initially received enalapril at high and then low doses. Patients continued to receive treatment with tapering doses of prednisolone; none received concomitant therapy with daily oral or intravenous steroids, alkylating agents, cyclosporine, non-steroidal anti-inflammatory drugs, and other antihypertensive medications. The urine albumin-to-creatinine (Ua/Uc) ratio and the percentage reduction were determined for each phase of therapy. Baseline clinical, biochemical, and histological features were comparable in the two groups. In the first phase, treatment with low-dose enalapril (group A) resulted in median 34.8% Ua/Uc reduction compared with 62.9% with high doses (group B) (P<0.01). High-dose enalapril was associated with a significant reduction in Ua/Uc ratio in both groups. The combined median Ua/Uc (95% confidence interval) reduction in the low-dose phase was 33% (−10.3% to 72.4%) and in the high-dose 52% (15.4%–70.4%) (P<0.05). The median Ua/Uc ratio at the end of 20 weeks was 1.1 and 1.8 in groups A and B, respectively (P>0.05). Systolic and diastolic blood pressure reductions were similar in both groups. No period or carry-over effect was found. Prolonged treatment with enalapril thus resulted in a dose-related reduction in nephrotic-range proteinuria. Titration of the dose of enalapril may be a useful strategy for achieving substantial reduction of proteinuria in children with SRNS.


Angiotensin-converting enzyme inhibitors Hyperlipidemia Proteinuria 


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Copyright information

© IPNA 2003

Authors and Affiliations

  • Arvind Bagga
    • 1
    • 3
  • Basanagoud D. Mudigoudar
    • 1
  • Pankaj Hari
    • 1
  • Vandita Vasudev
    • 2
  1. 1.Department of PediatricsAll India Institute of Medical SciencesIndia
  2. 2.Department of Laboratory MedicineAll India Institute of Medical SciencesNew DelhiIndia
  3. 3.Division of Nephrology, Department of PediatricsAll India Institute of Medical SciencesIndia

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