Effect of diet, enalapril, or losartan in post-diarrheal hemolytic uremic syndrome nephropathy
- PDF / 186,307 Bytes
- 8 Pages / 595.276 x 790.866 pts Page_size
- 61 Downloads / 192 Views
ORIGINAL ARTICLE
Effect of diet, enalapril, or losartan in post-diarrheal hemolytic uremic syndrome nephropathy Maria Gracia Caletti & Mabel Missoni & Clarisa Vezzani & María Grignoli & Juan Jose Piantanida & Horacio A. Repetto & Ramon Exeni & Stella Maris Rasse
Received: 15 April 2010 / Revised: 9 March 2011 / Accepted: 10 March 2011 / Published online: 30 April 2011 # IPNA 2011
Abstract Proteinuria is the main indicator of renal disease progression in many chronic conditions. There is currently little information available on the efficacy, safety, and individual tolerance of patients with post-diarrheal hemolytic uremic syndrome (D+ HUS) nephropathy to therapies involving diet, enalapril, or losartan. A multicenter, doubleblind, randomized controlled trail was conducted to evaluate the effect of a normosodic–normoproteic diet (Phase I) and the effect of normosodic–normoproteic diet plus enalapril (0.18–0.27 mg/kg/day) or losartan (0.89– 1.34 mg/kg/day) (Phase II) on children with D+ HUS, normal renal function, and persistent, mild (5.1–49.9 mg/kg/day) proteinuria. Dietary intervention reduced the mean protein intake from 3.4 to 2.2 mg/kg/day. Of 137 children, proteinuria normalized in 91 (66.4 %) within 23– 45 days; the remaining 46 patients were randomized to diet plus placebo (group 1, n=16), plus losartan (group 2, n=
16), or enalapril (group 3, n=14). In groups 1, 2, and 3, proteinuria was reduced by 30.0, 82.0, and 66.3%, respectively, and normalized in six (37.5%), three (81.3%), and 11 (78.6%) patients, respectively (χ2= 8.9, p=0.015). These results suggest that: (1) a normosodic–normoproteic diet can normalize proteinuria in the majority of children with D+ HUS with mild sequelae, (2) the addition of enalapril or losartan to such dietary restrictions of protein further reduces proteinuria, and (3) these therapeutic interventions are safe and well tolerated. Whether these short-term effects can be extended to the long-term remains to be demonstrated. Keywords Post-diarrheal hemolytic uremic syndrome . ACE inhibitors . Receptor blockers . Double-blind controlled trial . Protein intake
Introduction M. G. Caletti (*) : M. Missoni : C. Vezzani : M. Grignoli Hospital Garrahan, Buenos Aires, Argentina e-mail: [email protected] J. J. Piantanida Hospital de Niños R. Gutiérrez, Buenos Aires, Argentina H. A. Repetto Hospital Posadas, Buenos Aires, Argentina R. Exeni Hospital de Niños de San Justo, Buenos Aires, Argentina S. M. Rasse Hospital Zonal Materno Infantil, Mar del Plata, Argentina
Post-diarrheal hemolytic uremic syndrome (D+ HUS) is the second most prevalent cause of chronic renal failure (CRF) in children in Argentina, which has the highest incidence of this condition in the world [1, 2]. Currently, 5% of all affected children die in the acute stage, 55% have a favorable outcome, 5% develop end-stage renal disease (ESRD), and the remaining 35% evolve towards CRF after a variable period of time [3–5]. The study reported here focuses on this latter group. Research on chronic renal disease (CRD) in
Data Loading...
