Influence of early renoprotections on slow progression of chronic kidney disease in children
Keywords:
chronic kidney disease, children, renoprotection, enalapril, glomerular filtration rate, cystatin C, albumin excretion rate, albumin-to-creatinine ratio, serum potassiumAbstract
Objective: to evaluate the effect of early renoprotection on slowing the progression of chronic kidney disease in children (CKD).
Materials and methods. The effect of 5-year renoprotective therapy with an angiotensin-converting enzyme inhibitor (ACE inhibitor), enalapril, at a rate of 0.2–0.4 mg/kg per day, on the slowdown of the progression of CKD 1 st. in 25 children, based on a study of the dynamics of glomerular filtration rate (GFR), cystatin C (Cs C) level, albumin excretion rate (AER), albumin-to-creatinine ratio (ACR), 24-hour proteinuria, and serum potassium (SP) level.
Results. The use of enalapril reduced AER in daily urine from 141.4±10.1 mg/24 hours. up to 67.5±6.1 mg/24 hours after 5 years of treatment (p<0,001). ACR in daily urine decreased from 2.52±0.31 mg/mmol to 1.43±0.18 mg/mmol after 5 years of renoprotective therapy (p<0,01). Under the influence of treatment, the level of GFR increased on average by 4–8 ml/min/1.73 m2 in comparison with the initial data (after 1 year — p<0,01; after 5 years — p<0,05). The dynamics of Cs C showed a significant decrease in the values of this indicator from 0.77±0.0016 mg/l to 0.7±0.013 mg/l after 1 year (p<0.001) and to 0.71±0.014 mg/l after 5 years (p<0.01) renoprotective therapy. The concentration of SC during treatment was within the reference values in 92.0% of patients. After 1 year and slowing the progression of CKD 1 tbsp. achieved in 88,0% of the examined patients, after 5 years — in 92,0% of patients.
Conclusions. The early antiproteinuric effect of ACE inhibitors is associated with prolonged preservation of renal function in children with CKD. Reducing albuminuria, ACR and proteinuria should be considered an important goal in the treatment of CKD in children.
The research was carried out in accordance with the principles of the Helsinki Declaration. The study protocol was approved by the Local Ethics Committee of an participating institution. The informed consent of the patient was obtained for conducting the studies.
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