CLINICAL
STUDY OF FOSINOPRIL IN CHILDREN WITH STEROIDRESISTANT NEPHROTIC SYNDROME
Li Zhi-Hui, Yi Zhu-Wen
Laboratory of Pediatric Nephrology, The
Second Hospital of Xiang Ya School of Medicine, Central South
University, Changsha, China
Objective: In order to investigate the
relation between the renin-angiotensin system (RAS) and progressive renal
injury and study the treatment effects of ACE inhibitors in children with
steroid-resistant nephrotic syndrome.
Methods:30 boys and 15 girls with
steroid-resistant nephrotic syndrome were randomly divided into two groups:
group��: Treated with fosinopril and prednisone. Group��: Treated
with prednisone. 24h urinary protein was measured every 4 weeks until week 12.
Cholesterol (CHO), triglyceride(TG), high density lipoprotein(HDL) and low density
lipoprotein(LDL) in serum were measured at the beginning and the end of the
study. Serum ACE
was measured. Renin
activity (PRA) and angiotensin ��(AT��) in blood were detected. Retinol-binding
protein (RBP) and��2-microglobulin(��2-MG) were measured at the
beginning and the end of the study. Ten healthy children served as control
subjects.
Results: Serum levels of ACE, PRA and
AT�� in
steroid-resistant nephrotic syndrome
had no difference versus health subjects. It had no difference at
the beginning of the study compared with the end. At 4 weeks, 8 weeks and
12 weeks, 24h urinary protein was lower in the group��than in
the group��(P��0.01). At the end of study, the difference between group�� and
group�� was significant in the
level of serum CHO, TG and HDL (P<0.01). At the end of
the study, the levels of urine RBP and��2-MG in the
group�� were
lower than in the group��(P<0.01.).
Conclusions: RAS activity of systemic
circulation was normal and did not changed after long time ACEI treatment,
but RAS activity of renal may be increased in children with
steroid-resistant nephrotic syndrome. ACEI could diminish 24h urinary
protein, regulated the blood-lipid and remitted tubulointerstitium injury.