Nephroprotective therapy with angiotensin converting enzyme inhibitors effect evaluation on the course of chronic kidney disease in children with urinary system congenital malformations
THE AIM: to evaluate the effect of angiotensin-converting enzyme inhibitor (ACEI) therapy on the course of chronic kidney disease (CKD) in children with urinary system congenital malformations. PATIENTS AND METHODS. 119 patients with urinary system congenital malformations aged 3 to 18 years were examined. A control group of 10 clinically healthy children. There were 3 groups: I - 55 children with congenital vesicoureteral reflex, II - 34 children with congenital hydronephrosis, III - 30 children with other forms of urinary systems dysembryogenesis. ACEI therapy "Enap" ("KRKA", Slovenia), held for 6 months (children up to 14 years at a dose of 0.2 mg/kg/24 h in 1 reception, adolescents 5-10 mg/24 h in 1 reception). RESULTS. were evaluated according to clinical data, according to the daily monitoring of blood pressure (BP), renal function, renin concentration, plasma aldosterone. Renin and aldosterone production was determined in blood plasma (lying down) by enzyme immunoassay. Results. During ACEI treatment in all children there was stabilization of BP, renal function improvement. Patients with hypertension showed a significant decrease in the concentration of renin. ACEI therapy leads to normalization of aldosterone concentration in patients with hypertension and without hypertension. CONCLUSION. The analysis of the course of CKD in patients with US CM on the background of ACEI therapy demonstrates the main aspects of the anti-fibrotic action of the pharmacological blockade of the renin-aldosterone ACEI system.