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Vol. 55. Núm. 3.
Páginas 219-224 (septiembre 2001)
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Vol. 55. Núm. 3.
Páginas 219-224 (septiembre 2001)
Acceso a texto completo
Efecto a largo plazo de los inhibidores de la enzima conversora de la angiotensina en niños con proteinuria
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J.A. Camacho Díaz
Autor para correspondencia
jcamacho@hsjdbcn.org

Correspondencia: Hospital Sant Joan de Déu. P.° Sant Joan de Déu, 2. 08950 Esplugues. Barcelona.
, A. Giménez Llort, L. García García, R. Jiménez González
Sección Nefrología. Unidad Integrada Hospital Clínic-Hospital Sant Joan de Déu. Universidad de Barcelona
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Antecedentes

La proteinuria por sí misma representa un riesgo de lesión renal cuando se mantiene elevada de forma persistente a lo largo del tiempo. Los inhibidores de la enzima conversora de la angiotensina (IECA) pueden reducir la proteinuria en adultos con diversas nefropatías.

Pacientes y métodos

Se ha evaluado el efecto del tratamiento con dosis bajas de IECA (captopril y enalapril) en 9 niños con proteinuria afectados de nefropatía glomerular crónica. Los diagnósticos de los pacientes eran: nefropatía de Schönlein-Henoch, enfermedad de Berger, enfermedad de Alport y glomerulonefritis crónica (membranosa, focal y segmentaria y mesangiocapilar). En ningún caso debían recibir tratamiento concomitante, y se excluyeron aquellos que hubieran recibido corticoides, inmunosupresores o hipotensores en los últimos 3 meses. La medicación se administró durante un período de tiempo prolongado (tiempo medio = 26,6 + 6,36 meses).

Resultados

La proteinuria que era inicialmente de rango nefrótico (mujeres = 55,34 + 10,44 mg/m2/h) descendió en todos los casos de forma significativa a los 6 meses y al final del tratamiento (p < 0,01 y p < 0,05). No se han observado reacciones adversas a la medicación. El descenso en las cifras de filtrado glomerular no fue significativo. Tampoco se modificó de forma significativa la presión arterial durante el tratamiento.

Conclusiones

Los IECA pueden ser una alternativa eficaz en la reducción de la proteinuria en niños con nefropatías de larga evolución, sin los efectos secundarios de otros fármacos, por lo que pueden utilizarse durante tiempo prolongado.

Palabras clave:
Proteinuria
Niños
IECA
Background

Prolonged proteinuria is a risk factor for renal damage. Angiotensin-converting enzyme (ACE) inhibitors can reduce proteinuria in adults with different types of nephropathy.

Patients and methods

We evaluated treatment with low doses of ACE inhibitors (captopril and enalapril) in nine children with proteinuria due to chronic glomerular nephropathy. The patients’ diagnoses were Henoch-Schönlein nephropathy, Berger's disease, Alport's disease, and chronic glomerulonephritis (GN) (membranous GN, focal and segmental GN, and membranoproliferative GN). None of the patients were receiving concomitant treatment. Those who had received corticoids, immunosuppressive or hypotensive drugs during the previous 3 months were excluded. The medication was administered over a prolonged period (mean 26.6 + 6.36 months).

Results

Proteinuria was initially in the nephrotic range (M = 55.34 + 10.44 mg/m2/h). In all patients concentrations fell significantly after 6 months and at the end of the treatment (p < 0.01 and p < 0.05). No adverse reactions to the medication were observed. The decrease in glomerular filtration rate was not significant. No significant changes in arterial pressure were found during treatment.

Conclusions

ACE inhibitors could be an effective alternative for reducing proteinuria in children with prolonged nephropathy. These inhibitors do not produce the adverse effects associated with other drugs and can therefore be used for long periods.

Key words:
Proteinuria
Children
Angiotensin-converting enzyme inhibitors
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Copyright © 2001. Asociación Española de Pediatría
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