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Systemic Hypertension and Proteinuria in Childhood Chronic Renal Parenchymal Disease

Role of Antihypertensive Drug Management

  • Therapy In Practice
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Abstract

A variety of chronic kidney diseases tend to progress towards end-stage kidney disease. Progression is largely due to factors unrelated to the initial disease, including systemic hypertension and proteinuria. Drugs that block the renin-angiotensin II-aldosterone system, either ACE inhibitors or angiotensin II receptor antagonists, reduce both BP and proteinuria and appear superior to a more conventional antihypertensive treatment regimen in preventing progression to end-stage kidney disease. The most recent recommendations state that the BP goal in children with chronic kidney disease is the corresponding 90th centile for body height, age, and gender.

Since satisfactory BP control is often not achieved, the mnemonic acronym DELTAREPROSI was generated to recall the following tips for the practical management of hypertension and proteinuria in childhood chronic renal parenchymal disease: DEfinition of hypertension and Low blood pressure TArget in REnal disease (90th centile calculated by means of simple formulas), potential of drugs inhibiting the REnin-angiotensin II-aldosterone system in hypertension and PROteinuria, advantages of SImplified treatment regimens and escalating the doses every SIx weeks.

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References

  1. Hales CN. Suicide of the nephron. Lancet 2001; 357: 136–7

    Article  PubMed  CAS  Google Scholar 

  2. Remuzzi G, Ruggenenti P, Perico N. Chronic renal diseases: renoprotective benefits of renin-angiotensin system inhibition. Ann Intern Med 2002; 136: 604–15

    PubMed  CAS  Google Scholar 

  3. Soares CM, Oliveira EA, Diniz JS, et al. Predictive factors of progression of chronic renal insufficiency: a multivariate analysis. Pediatr Nephrol 2003; 18: 371–7

    PubMed  Google Scholar 

  4. Parekh RS, Carroll CE, Wolfe RA, et al. Cardiovascular mortality in children and young adults with end-stage kidney disease. J Pediatr 2002; 141: 191–7

    Article  PubMed  CAS  Google Scholar 

  5. Chavers BM, Li S, Collins AJ, et al. Cardiovascular disease in pediatric chronic dialysis patients. Kidney Int 2002; 62: 648–53

    Article  PubMed  Google Scholar 

  6. Groothoff JW. Long-term outcomes of children with end-stage renal disease. Pediatr Nephrol 2005; 20: 849–53

    Article  PubMed  CAS  Google Scholar 

  7. Lopes AA. Hypertension in black people: pathophysiology and therapeutic aspects. J Hum Hypertens 2002; 16(1 Suppl.): S11–2

    Article  PubMed  Google Scholar 

  8. van der Vorst MM, Kist JE, van der Heijden AJ, et al. Diuretics in pediatrics: current knowledge and future prospects. Paediatr Drugs 2006; 8: 245–64

    Article  PubMed  Google Scholar 

  9. Dworkin LD, Shemin DG. Antihypertensive therapy and progression of chronic renal disease. Curr Hypertens Rep 1999; 1: 417–22

    Article  PubMed  CAS  Google Scholar 

  10. Textor SC, Canzanello VJ, Epstein M, et al. What is the optimal strategy to intensify blood pressure control and prevent progression of renal failure? Curr Hypertens Rep 2001; 3: 422–8

    Article  Google Scholar 

  11. Weir MR. Progressive renal and cardiovascular disease: optimal treatment strategies. Kidney Int 2002; 62: 1482–92

    Article  PubMed  Google Scholar 

  12. Wingen AM, Fabian-Bach C, Schaefer F, et al. Randomised multicentre study of a low-protein diet on the progression of chronic renal failure in children. European Study Group of Nutritional Treatment of Chronic Renal Failure in Childhood. Lancet 1997; 349: 1117–23

    Article  PubMed  CAS  Google Scholar 

  13. Wenzel U. Aldosterone antagonists: silver bullet or just sodium excretion and potassium retention? Kidney Int 2007; 71: 374–6

    Article  PubMed  CAS  Google Scholar 

  14. Kloke HJ, Branten AJ, Huysmans FT, et al. Antihypertensive treatment of patients with proteinuric renal diseases: risks or benefits of calcium channel blockers? Kidney Int 1998; 53: 1559–73

    Article  PubMed  CAS  Google Scholar 

  15. Hayashi K, Ozawa Y, Fujiwara K, et al. Role of actions of calcium antagonists on efferent arterioles with special references to glomerular hypertension. Am J Nephrol 2003; 23: 229–44

    Article  PubMed  CAS  Google Scholar 

  16. Tobe S. Update on calcium antagonists and the kidney. Curr Opin Nephrol Hypertens 2003; 12: 309–15

    Article  PubMed  CAS  Google Scholar 

  17. Sahney S. A review of calcium channel antagonists in the treatment of pediatric hypertension. Paediatr Drugs 2006; 8: 357–73

    Article  PubMed  Google Scholar 

  18. National Kidney Foundation. K/DOQI clinical practice guidelines on hypertension and antihypertensive agents in chronic kidney disease. Am J Kidney Dis 2004; 1Suppl. 43: 1–290

    Google Scholar 

  19. National High Blood Pressure Education Program Working Group on High Blood Pressure in Children and Adolescents. The fourth report on the diagnosis, evaluation, and treatment of high blood pressure in children and adolescents. Pediatrics 2004; 114: 555–76

    Article  Google Scholar 

  20. Somu S, Sundaram B, Kamalanathan AN. Early detection of hypertension in general practice. Arch Dis Child 2003; 88: 302

    Article  PubMed  CAS  Google Scholar 

  21. Bianchetti MG, Ardissino G, Fossali E, et al. Hypertension in children and adolescents. J Hypertens 2004; 22: 2227

    Article  PubMed  CAS  Google Scholar 

  22. Wühl E, Mehls O, Schaefer F, et al. Antihypertensive and antiproteinuric efficacy of ramipril in children with chronic renal failure. Kidney Int 2004; 66: 768–76

    Article  PubMed  Google Scholar 

  23. Palmer BF. Angiotensin-converting enzyme inhibitors and angiotensin receptor blockers: what to do if the serum creatinine and/or serum potassium concentration rises. Nephrol Dial Transplant 2003; 18: 1973–5

    Article  PubMed  CAS  Google Scholar 

  24. Perazella MA. Drug-induced hyperkalemia: old culprits and new offenders. Am J Med 2000; 109: 307–14

    Article  PubMed  CAS  Google Scholar 

  25. Woroniecki RP, Flynn JT. How are hypertensive children evaluated and managed? A survey of North American pediatric nephrologists. Pediatr Nephrol 2005; 20: 791–7

    Article  PubMed  Google Scholar 

  26. Bianchetti MG, Ammenti A, Avolio L, et al. Prescription of drugs blocking the renin-angiotensin system in Italian children. Pediatr Nephrol 2007; 22: 144–8

    Article  PubMed  Google Scholar 

  27. Ardissino G, Daccò V, Testa S, et al. Epidemiology of chronic renal failure in children: data from the ItalKid project. Pediatrics 2003; 111 (2 Pt 1): 382–7

    Article  Google Scholar 

  28. Hilgers KF, Dötsch J, Rascher W, et al. Treatment strategies in patients with chronic renal disease: ACE inhibitors, angiotensin receptor antagonists, or both? Pediatr Nephrol 2004; 19: 956–61

    Article  PubMed  Google Scholar 

  29. Sieber US, von Vigier RO, Sforzini C, et al. How good is blood pressure control among treated hypertensive children and adolescents? J Hypertens 2003; 21: 633–7

    Article  PubMed  CAS  Google Scholar 

  30. Nevins TE. “Why do they do that?” The compliance conundrum. Pediatr Nephrol 2005; 20: 845–8

    Article  PubMed  Google Scholar 

  31. Bloom BS. Daily regimen and compliance with treatment. BMJ 2001; 323: 647

    Article  PubMed  CAS  Google Scholar 

  32. Flack JM, Yunis C, Preisser J, et al. The rapidity of drug dose escalation influences blood pressure response and adverse effects burden in patients with hypertension: the Quinapril Titration Interval Management Evaluation (ATIME) Study. ATIME Research Group. Arch Intern Med 2000; 160: 1842–7

    Article  PubMed  CAS  Google Scholar 

  33. von Vigier RO, Bianchetti MG. Arterielle hypertonie im kindes- und adoles-zentenalter. Ther Umsch 1999; 56: 12–8

    Article  Google Scholar 

  34. Simonetti GD, Fossali E, Ramelli GP, et al. Prise en charge pharmacologique de l’hypertension artérielle chronique chez l’enfant: KISS, please. Rev Med Suisse 2005; 1: 1307–10

    PubMed  CAS  Google Scholar 

  35. Ardissino G, Edefonti A, Bianchetti MG, et al. Criteri diagnostici e terapeutici dell’ipertensione arteriosa in età pediatrica. G Ital Nefrol 2006; 23: 149–62

    PubMed  CAS  Google Scholar 

  36. Bianchetti MG, Ardissino G, Fossali E, et al. Tips for the use of antihypertensive drugs: DELTAREPROSI. J Pediatr 2004; 145: 288–90

    Article  PubMed  Google Scholar 

  37. Phillips LS, Branch WT, Cook CB, et al. Clinical inertia. Ann Intern Med 2001; 135: 825–34

    PubMed  CAS  Google Scholar 

  38. Kaplan NM. Resistant hypertension. J Hypertens 2005; 23: 1441–4

    Article  PubMed  CAS  Google Scholar 

  39. Lurbe E, Sorof JM, Daniels SR. Clinical and research aspects of ambulatory blood pressure monitoring in children. J Pediatr 2004; 144: 7–16

    Article  PubMed  Google Scholar 

  40. Calhoun DA. Use of aldosterone antagonists in resistant hypertension. Prog Cardiovasc Dis 2006; 48: 387–96

    Article  PubMed  CAS  Google Scholar 

  41. Sica DA. Minoxidil: an underused vasodilator for resistant or severe hypertension. J Clin Hypertens (Greenwich) 2004; 6: 283–7

    Article  Google Scholar 

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Acknowledgments

Giacomo D. Simonetti is supported by the Fondazione Ettore e Valeria Rossi. No sources of funding were used to assist in the preparation of this review. The authors have no conflicts of interest that are directly relevant to the content of this review.

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Authors and Affiliations

  1. Division of Pediatric Nephrology, University of Berne, Berne, Switzerland

    Giacomo D. Simonetti

  2. Department of Pediatrics, Ospedale San Giovanni, Bellinzona and Ospedale Beata Vergine, Mendrisio, Switzerland

    Laura Santoro, Alessandra Ferrarini, Laura Crosazzo-Franscini &  Mario G. Bianchetti

  3. Pediatric Renal Unit, Fondazione Ospedale Maggiore Policlinico, Mangiagalli e Regina Elena, IRCCS, Milan, Italy

    Emilio Fossali &  Mario G. Bianchetti

Authors
  1. Giacomo D. Simonetti
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  2. Laura Santoro
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  3. Alessandra Ferrarini
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  4. Laura Crosazzo-Franscini
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  5. Emilio Fossali
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  6. Mario G. Bianchetti
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Correspondence to Mario G. Bianchetti.

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Simonetti, G.D., Santoro, L., Ferrarini, A. et al. Systemic Hypertension and Proteinuria in Childhood Chronic Renal Parenchymal Disease. Pediatr Drugs 9, 413–418 (2007). https://doi.org/10.2165/00148581-200709060-00008

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