Renoprotective Effect of Losartan Versus Enalapril in Children with Chronic Kidney Disease

Abstract

Background: Proteinuria is a marker of severity of chronic kidney disease)CKD) and leads to progression to end stage renal disease which can be reduced by blocking renin angiotensin aldosterone system(RAAS) through angiotensin converting enzyme inhibitors(ACEis) (e.g . enalapril) and angiotensin receptor blockers (ARBs) (e.g. losartan( Aim of the Work: To evaluate the renoprotective effect of losartan versus enalapril in children with CKD. Patients and Methods: This prospective cohort study was conducted on Sixty CKD children aged (5 to 17 years), were subdivided into three groups as the following: group I; 20 patients received enalapril, group II; 20 patients received losartan, group III; 20 patients didn’t receive losartan nor enalapril. All patients were subjected to thorough history, clinical evaluation and laboratory investigations (blood urea, serum creatinine, GFR, 24hours urinary  proteins, serum albumin, lipid profile and serum electrolytes) initially and after 6monthes of treatment. Results: this prospective cohort study was conducted on 34males and 26 females CKD children. Steroid dependantnephrotic syndrome (SDNS) was the commonest cause (53.3%)followed by diabetic nephropathy (DN)(15%), lupus nephritis(LN) (12%) and only 1 case was frequent relapse NS (FRNS). protienuria improved with 76.7% reduction in losartan group versus 45.6%reduction in enalapril group after 6 months of treatment. GFR increased by( 4.5%,8.6%)  in losartan and enalapril groups respectively. Serum creatinine decreased by(11.6% and 8.3%) in losartan and enalapril groups respectively. Conclusions: losartan and enalapril have a role in controlling proteinuria distinct from their  antihypertensive effect .