Enalapril and prednisone in children with nephrotic-range proteinuria

The effect of enalapril and low prednisone doses on the urinary protein ele ctrophoretic pattern was studied in 13 pediatric patients with glomerular d iseases and steroid-resistant nephrotic syndrome. Enalapril was administred at doses of 0.2-0.6 mg/kg per day for 24-84 months, and prednisone was int roduced 2 months later in II patients at doses of 30 mg/m(2) on alternate d ays. The urine protein electrophoretic pattern showed a reduction of 80% an d 70% in the total protein and albumin, respectively, after enalapril. Tota l urinary protein decreased from 5.46 to 1.1 g/m(2) per day (P<0.001). A ma rked change from a pattern of non-selective urinary protein loss to an albu min-selective proteinuria was observed. Mean total plasma proteins increase d from 4.7 to 5.43 g/dl (P<0.001). Four patients became foe of proteinuria 24 months after enalapril was started, but only 2 remained free of proteinu ria at 48 months of follow-up. The other 11 patients had persistent albumin uria of between 0.5 and 2.6 g/m(2) per day with a selective urinary electro phoretic pattern. No additional decrease was observed after steroids were i ntroduced. A clinical improvement in edema was observed in all children, Th ree patients developed transient acute renal failure, during the course of an infectious disease; 2 developed peritonitis and I pneumopathy. In these patients withdrawal of enalapril was necessary until a complete recovery or renal function was observed. Four patients were hypertensive on admission, achieving normal blood pressure 1 month after enalapril was started. No ep isodes of systemic arterial hypotension were seen. Creatinine clearance and serum potassium showed no statistically significant change.