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Pediatr Nephrol ; 28(5): 737-43, 2013 May.
Artigo em Inglês | MEDLINE | ID: mdl-23207876

RESUMO

BACKGROUND: A previous subgroup analysis of a 12-week, double-blind study demonstrated that losartan significantly lowered proteinuria versus placebo and amlodipine and was well tolerated in children (1-17 years old) with proteinuria secondary to Alport syndrome. The present subgroup analysis of the open-label, extension phase of this study assessed the long-term efficacy and tolerability of losartan versus enalapril. METHODS: Patients who had completed the double-blind study were re-randomized to losartan or enalapril and followed for proteinuria and renal function for up to 3 years. RESULTS: Twenty-seven patients with Alport syndrome were randomized to losartan (0.44-2.23 mg/kg/day; n = 15) or enalapril (0.07-0.72 mg/kg/day; n = 12). The least-squares (LS) mean percent change from week 12 in urinary protein to creatinine ratio (UPr/Cr was +1.1 % in the losartan group versus a further 13.9 % reduction in the enalapril group (GMR [95 % CI] = 1.2 [0.7, 2.0]); the LS mean change from week 12 in estimated glomerular filtration rate (eGFR) was -6.4 ml/min/1.73 m(2) in the losartan group versus -9.1 ml/min/1.73 m(2) in the enalapril group. The adverse event incidence was low and comparable in both treatment groups. CONCLUSIONS: In children with proteinuria secondary to Alport syndrome, losartan maintained proteinuria reduction, and enalapril produced a further proteinuria reduction over the 3-year study period. Both agents were generally well tolerated.


Assuntos
Inibidores da Enzima Conversora de Angiotensina/uso terapêutico , Enalapril/uso terapêutico , Rim/efeitos dos fármacos , Losartan/uso terapêutico , Nefrite Hereditária/tratamento farmacológico , Proteinúria/tratamento farmacológico , Adolescente , Bloqueadores do Receptor Tipo 1 de Angiotensina II/efeitos adversos , Bloqueadores do Receptor Tipo 1 de Angiotensina II/uso terapêutico , Inibidores da Enzima Conversora de Angiotensina/efeitos adversos , Ásia , Biomarcadores/urina , Criança , Pré-Escolar , Creatinina/urina , Método Duplo-Cego , Enalapril/efeitos adversos , Europa (Continente) , Feminino , Taxa de Filtração Glomerular/efeitos dos fármacos , Humanos , Lactente , Rim/fisiopatologia , Análise dos Mínimos Quadrados , Losartan/efeitos adversos , Masculino , Nefrite Hereditária/complicações , Nefrite Hereditária/diagnóstico , Nefrite Hereditária/fisiopatologia , Nefrite Hereditária/urina , Proteinúria/diagnóstico , Proteinúria/etiologia , Proteinúria/fisiopatologia , Proteinúria/urina , América do Sul , Fatores de Tempo , Resultado do Tratamento , Estados Unidos
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