Abstract
Background
The aim of this study was to analyze the long-term efficacy and safety of angiotensin-converting enzyme inhibitor (ACEi) and ACEi + angiotensin receptor blocker (ARB) treatments in a cohort of children with Alport syndrome (AS).
Methods
This was a respective review of 79 Chinese children with AS who received ACEi alone or combined ACEi + ARB therapy.
Results
The mean age of the pediatric patients with AS at onset of treatment was 8.6 ± 4.1 (range 1.5–16.3) years. The mean duration of follow-up was 2.5 ± 1.8 (range 0.5–7.8) years. For analysis, we separated the children into three groups according to proteinuria level before treatment, namely, <25, 25–50, and ≥50 mg/kg/day, respectively; after 1 year of treatment the proteinuria had decreased from 11.0 to 9.7 mg/kg/day, from 34.6 to 15.2 mg/kg/day, and from 73.0 to 50.0 mg/kg/day in each group, respectively. Proteinuria decreased significantly during the first 2 years of treatment and was stable from the third to fifth years of treatment. There was no statistically significant difference in the antiproteinuric effect of the ACEi and ACEi + ARB treatments in patients with severe or less severe mutations after 1 year of therapy. Five children stopped the ACEi + ARB treatment due to a decline in creatinine clearance.
Conclusion
Our findings demonstrate that early and long-term ACEi and ARB treatments in children with AS is efficient and well tolerated. The antiproteinuric effect of ACEi and ARB is of equal value in children with severe and less severe mutations in the COL4An gene.
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Conflict of interest
The authors declared that they have no conflict of interest.
Ethical disclosure
This study was approved by the Ethical Committee of Peking University First Hospital and parental/patient consent was not required due to the retrospective nature of the study.
Financial statement
This study was supported by grants from the National Nature Science Foundation (30801252 81070545, and 81400685), the Beijing Nature Science Foundation (7102148), and the National “Twelfth Five-Year” Science and Technology Support Project (2012BAI03B02).
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Zhang, Y., Wang, F., Ding, J. et al. Long-term treatment by ACE inhibitors and angiotensin receptor blockers in children with Alport syndrome. Pediatr Nephrol 31, 67–72 (2016). https://doi.org/10.1007/s00467-015-3184-5
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DOI: https://doi.org/10.1007/s00467-015-3184-5