Effect of lisinopril on proteinuria in children with

I.
Pediatr Nephrol (2003) 18:727-728
DOl 1O.1007/s00467-003-1103-7
LETTER
TO THE
EDJTORS
Olanrewaju T. Adedoyin . Mary O. Ologe
Emmanuel A. Anigilaje . Adeoye Adeniyi
Effect of lisinopril on proteinuria in children with nephrotic syndrome
in lIorin, Nigeria
Published online: 7 May 2003
© IPNA 2003
Keywords
children
Lisinopril· Nephrotic syndrome· Nigerian
Sirs,
Nephrotic syndrome (NS) is a common childhooddisorder worldwide [1, 2]. Steroids remain the mainstay of
treatment in NS, even though resistance to steroid therapy is well documented [3]. Steroid-resistant NS continues to ,?ose therapeutic problems and many alternative
drugs, including angiotensin converting enzyme inhibitors (ACED, have been tried under these circumstances
[4, 5]. However, most studies of the efficacy of ACE!
were conducted in Caucasians; few, if any, have been
performed in a predominantly black population in developing nations. This report details our experience with the
use of lisinopril in children with steroid-resistant NS living in Nigeria.
A retrospective review of steroid-resistant NS patients
was carried out. Patients who were treated with lisinopril
were compared with those who were treated similarly for
their NS except they did not receive lisinopril. In the lisinopril group, patients aged less than 5 years received
5 mg of drug daily, while 10 mg was given to patients
5 years of age or older. The University of llorin Teaching
Hospital where this study was conducted is located in
O. T. Adedoyin . E. A. Anigilaje . A. Adeniyi
Department of Pediatrics,
University of Borin Teaching Hospital,
Borin, Nigeria
M. O. Ologe
Department of Pharmacology and Therapeutics,
University of llorin Teaching Hospital,
Ilorin, Nigeria
O. T. Adedoyin (~)
Division of Nephrology,
Schneider Children's Hospital,
269-01, 76th Avenue, New Hyde Park, NY 11040-1432, USA
e-mail: oadedoyi@lij.edu
Tel.: + 1-718-4703491, Fax: + 1-718-4700887
Kwara State in the North-Central region of Nigeria, with
a population of about 3 million people.
There were 25 patients studied, 18 males and 7 females. The lisinopril group contained 12 males and 2 females with an age range of 3-15 years (mean 8.7 years).
The histological characteristics of only 4 patients were
known; 2 had minimal change NS (MCNS) and 2 focal
and segmental glomerulosclerosis. The duration of
lisinopril therapy ranged from 0.3 to 8.5 months (mean
3.9 months). Only 2 (14.2%) of the 14 patients on
lisinopril responded completely to treatment, with resolution of proteinuria after 4 and 4.5 months of therapy,
respectively. Relapses, defined as recurrence of proteinuria or edema, occurred in 4 (28.4%) children (1 or 2 per
patient) during the period of lisinopril administration.
One death occurred in this group. This patient needed
several rounds of peritoneal dialysis for acute renal failure, which he could not afford.
The non-lisinopril group contained 11 patients
(6 males and 5 females). The age range was 4-14 years
(mean 9.5 years). The histological lesion was known for
3 patients: 2 children had MCNS and 1 had mesangiocapillary nephritis. Relapses were documented in 4
(36.4%) patients. Three (27.3%) deaths occurred in this
group as a result of renal failure following NS. Unfortunately, the families could not afford dialysis.
Our results indicate that less than 20% of patients given lisinopril responded with complete remission of proteinuria. The rate of persistent proteinuria was similar regardless of whether or not they received lisinopril. Furthermore, the number of relapses and the mortality rate
in the lisinopril and non-lisinopril group were essentially
the same, indicating that ACEI offer no particular advantage. However, there may be a beneficial effect on proteinuria in patients who receive lisinopril for at least
3 months. Our 2 patients who responded had been treated for 4-4.5 months, suggesting that a minimum of
3 months of lisinopril therapy is needed to assess response to treatment.
We conclude that lisinopril may have modest benefits
in the control of proteinuria among select children with
728
steroid-resistant NS in a homogenously black population
living in Nigeria. ACEI-induced remissions in steroid-resistant NS may require a minimum of 4 months of treatment. However, despite these limitations, ACE! therapy
can be safely utilized even in developing countries,
where renal biopsies, serum biochemical monitoring, and
quantitation of urinary protein excretion may sometimes
be difficult to implement.
Acknowledgements
The authors are grateful to Howard Trachtman, MD (Director, Division of Pediatric Nephrology, North
Shore-Long
Island Jewish Health System, New York, USA) for
reviewing the manuscript and offering useful suggestions. Dr. O.T.
Adedoyin is a Fellow of the International Society of Nephrology
(ISN).
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