Pediatric Nephrology

, Volume 21, Issue 7, pp 967–972 | Cite as

Effect of fosinopril in children with steroid-resistant idiopathic nephrotic syndrome

  • Zhuwen Yi
  • Zhihui Li
  • Xiao-Chuan Wu
  • Qing-Nan He
  • Xi-Qiang Dang
  • Xiao-Jie He
Original Article


We aimed to test if fosinopril reduces urinary protein excretion and alleviates renal tubular damage in normotensive children with steroid-resistant idiopathic nephrotic syndrome (SRINS). We also aimed to evaluate whether there are changes in steady-state blood pressure and serum concentrations of serum angiotensin-converting enzyme (ACE) and plasma renin activity or angiotensin II (AT-II) in children under this treatment. Forty-five normotensive patients with SRINS were randomly divided into two groups. Group I was treated with fosinopril and prednisone for 12 weeks, while group II was treated with prednisone alone for the same duration. The values of 24-h urinary protein excretion were 1.25±0.64 vs 2.52±0.56 g/24 h (P<0.05), 1.16±0.45 vs 2.42±0.24 g/24 h (P<0.05), and 1.10±0.41 vs 2.05±0.46 g/24 h (P<0.05) in group I and group II patients, respectively, at 4, 8, and 12 weeks. Patients in group I showed lower serum concentrations of urinary retinol-binding protein and β2-microglobulin (P<0.01) at the end of the study, but the patients’ blood pressure and components of the renin-angiotensin system (RAS) had no change during treatment. The result suggested that fosinopril significantly reduced proteinuria and alleviated renal tubular damage, but did not influence blood pressure and components of systemic RAS in normotensive children with SRINS.


Idiopathic nephrotic syndrome Steroid resistant Fosinopril Children 



This work was supported by Ministry of Health Science Foundation of China (98-1-117). The authors thank all colleagues who meticulously kept medical records, managed the patients, renal biopsies, and who assisted with follow-up. We thank Dr. Man Chun Chiu of Princess Margaret Hospital of Hong Kong for his advice and comments.


  1. 1.
    El-Husseini A, El-Basuony F, Mahmoud I, Donia A (2004) Co-administration of cyclosporine and ketoconazole in idiopathic childhood nephrosis. Pediatr Nephrol 19:976–981PubMedCrossRefGoogle Scholar
  2. 2.
    Ejaz I, Khan HI, Javaid BK, Rasool G (2004) Histopathological diagnosis and outcome of paediatric nephrotic syndrome. J Coll Physicians Surg Pak 14:229–233PubMedGoogle Scholar
  3. 3.
    Bonilla-Felix M, Parra C, Dajani T, Ferris M, Swinford RD, Portman RJ, Verani R (1999) Changing patterns in the histopathology of idiopathic nephrotic syndrome in children. Kidney Int 55:1885–1890PubMedCrossRefGoogle Scholar
  4. 4.
    Sorof JM, Hawkins EP, Brewer ED, Boydstun II, Kale AS, Powell DR (1998) Age and ethnicity affect the risk and outcome of focal segmental glomerulosclerosis. Pediatr Neprhol 12:764–768CrossRefGoogle Scholar
  5. 5.
    Korbet SM, Genchi RM, Borok RZ, Schwartz MM (1996) The racial prevalence of glomerular lesions in nephrotic adults. Am J Kidney Dis 27:647–651PubMedCrossRefGoogle Scholar
  6. 6.
    Southwest Pediatric Nephrology Study Group (1985) Focal segmental glomerulosclerosis in children with idiopathic nephritic syndrome: a report of the Southwest Pediatric Nephrology Study Group. Kidney Int 27:442–449CrossRefGoogle Scholar
  7. 7.
    Mezzano SA, Ruiz-Ortega M, Egido J (2001) Angiotensin II and renal fibrosis. Hypertension 38:635–638PubMedCrossRefGoogle Scholar
  8. 8.
    Hohenfellner K, Fogo A, Kon V (1999) Renin-angiotensin genes in renal development and the occurrence and progression of renal diseases. Semin Nephrol 19:148–154PubMedGoogle Scholar
  9. 9.
    Marcantoni C, Ortalda V, Lupo A, Maschio G (1998) Progression of renal failure in diabetic nephropathy. Nephrol Dial Transplant 8:16–19CrossRefGoogle Scholar
  10. 10.
    Johnston CI, Risvanis J, Naitoh M, Tikkanen I (1998) Mechanism of progression of renal disease: current hemodynamic concepts. J Hypertens Suppl 16:S3–S7PubMedCrossRefGoogle Scholar
  11. 11.
    Remuzzi A, Perticucci E, Ruggenenti P, Mosconi L, Limonta M, Remuzzi G (1991) Angiotensin converting enzyme inhibition improves glomerular size-selectivity in IgA nephropathy. Kidney Int 39:1267–1273PubMedCrossRefGoogle Scholar
  12. 12.
    Sasinka MA, Podracka L, Boor A, Jurkovic I, Mitro A, Kovacs L (1999) Enalapril treatment of proteinuria in normotensive children. Bratisl Lek Listy 100:476–480PubMedGoogle Scholar
  13. 13.
    Chiarelli F, Casani A, Verrotti A, Morgese G, Pinelli L (1998) Diabetic nephropathy in children and adolescents: a critical review with particular reference to angiotensin-converting enzyme inhibitors. Acta Paediatr 425:42–45CrossRefGoogle Scholar
  14. 14.
    Soergel M, Verho M, Wuhl E, Gellermann J, Teichert L, Scharer K (2000) Effect of ramipril on ambulatory blood pressure and albuminuria in renal hypertension. Pediatr Nephrol 15:113–118PubMedCrossRefGoogle Scholar
  15. 15.
    Delucchi A, Cano F, Rodriguez E, Wolff E, Gonzalez X, Cumsille MA (2000) Enalapril and prednisone in children with nephrotic-range proteinuria. Pediatr Nephrol 14:1088–1091PubMedCrossRefGoogle Scholar
  16. 16.
    Lama G, Luongo I, Piscitelli A, Salsano ME (2000) Enalapril: antiproteinuric effect in children with nephrotic syndrome. Clin Nephrol 53:432–436PubMedGoogle Scholar
  17. 17.
    Adler L, Mathew R, Futterweit S, Frank R, Gauthier BG, Kashtan CE, Trachtman H (2002) Angiotensin converting enzyme inhibitor therapy in children with Alport syndrome: effect on urinary albumin, TGF-beta, and nitrite excretion. BMC Nephrol 3:2PubMedCrossRefGoogle Scholar
  18. 18.
    Parving HH, Hommel E, Smidt UM (1988) Protection of the kidney function and decrease in albuminuria by captopril in insulin dependent diabetics with nephropathy. BMJ 297: 1086–1091PubMedCrossRefGoogle Scholar
  19. 19.
    Maschio G, Alberti D, Janin G, Locatelli F, Mann JF, Motolese M, Ponticelli C, Ritz E, Zucchelli P (1996) Effect of the angiotensin-converting-enzyme inhibitor benazepril on the progression of chronic renal insufficiency. The Angiotensin-Converting-Enzyme Inhibition in Progressive Renal Insufficiency Study Group. N Engl J Med 334:939–945PubMedCrossRefGoogle Scholar
  20. 20.
    Prasher PK, Varma PP, Baliga KV (1999) Efficacy of enalapril in the treatment of steroid resistant idiopathic nephrotic syndrome. J Assoc Physicians India 47:180–182PubMedGoogle Scholar
  21. 21.
    Guez S, Giani M, Melzi ML, Antignac C, Assael BM (1998) Adequate clinical control of congenital nephrotic syndrome by enalapril. Pediatr Nephrol 12:130–132PubMedCrossRefGoogle Scholar
  22. 22.
    Proesmans W, Van Dyck M (2004) Enalapril in children with Alport syndrome. Pediatr Nephrol 19:271–275PubMedCrossRefGoogle Scholar
  23. 23.
    Bagga A, Mudigoudar BD, Hari P, Vasudev V (2004) Enalapril dosage in steroid-resistant nephrotic syndrome. Pediatr Nephrol 19:45–50PubMedCrossRefGoogle Scholar
  24. 24.
    Butani L (2003) Remission of membranoproliferative nephritis with angiotensin converting enzyme inhibition and receptor blockade. Pediatr Nephrol 18:1199PubMedCrossRefGoogle Scholar
  25. 25.
    White CT, Macpherson CF, Hurley RM, Matsell DG (2003) Antiproteinuric effects of enalapril and losartan: a pilot study. Pediatr Nephrol 18:1038–1043PubMedCrossRefGoogle Scholar
  26. 26.
    Miller DS, Morgenstern BZ (1991) Angiotensin converting enzyme inhibitors for reduction of proteinuria in children with steroid-resistant nephrotic syndrome. Pediatr Nephrol 5:587–590CrossRefGoogle Scholar

Copyright information

© IPNA 2006

Authors and Affiliations

  • Zhuwen Yi
    • 1
  • Zhihui Li
    • 2
  • Xiao-Chuan Wu
    • 1
  • Qing-Nan He
    • 1
  • Xi-Qiang Dang
    • 1
  • Xiao-Jie He
    • 1
  1. 1.Laboratory of Pediatric Nephrology, Institute of Pediatrics, The Second Xiangya HospitalCentral South University & Hunan Province Clinical Center of Pediatric NephrologyChangshaPeople’s Republic of China
  2. 2.Department of NephrologyHunan Province Children’s HospitalChangshaPeople’s Republic of China

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