Journal Article

Strict Blood-Pressure Control and Progression of Renal Failure in Children

Montini, Giovanni, Schaefer, Franz, Testa, Sara, Picca, Stefano, Anarat, Ali, Caldas-Afonso, Alberto, Dusek, Jiri, Caliskan, Salim, Peco-Antic, Amira, Jankauskiene, Augustina, Wygoda, Simone, Jeck, Nikola, Emre, Sevinc, Drozdz, Dorota, Mehls, Otto, Urasinski, Tomasz, Hohbach-Hohenfellner, Katharina, Wigger, Marianne, Trivelli, Antonella, Enke, Barbara, Wingen, Ann-Margret, Mir, Sevgi, Möller, Kristina, Bakkaloglu, Aysin, Litwin, Mieczyslaw, Arbeiter, Klaus, Berg, Ulla, Gellermann, Jutta, Sallay, Peter, Niaudet, Patrick, Neuhaus, Thomas, Zurowska, Aleksandra, Wühl, Elke, Peruzzi, Licia, Fischbach, Michel

2009

Overview

This study assessed the long-term renoprotective effect of intensified blood-pressure control among children receiving a fixed high dose of an angiotensin-converting–enzyme inhibitor. Intensified blood-pressure control, achieved with additional medication, to reach a targeted 24-hour blood pressure in the low range of normal appeared to confer a substantial benefit with respect to a delay in the progression of renal disease among children with chronic kidney disease. However, reappearance of proteinuria after initial successful pharmacologic control was common. Intensified blood-pressure control to reach a targeted 24-hour blood pressure in the low range of normal appeared to confer a substantial benefit with respect to a delay in the progression of renal disease among children with chronic kidney disease. However, reappearance of proteinuria was common. Among both adults and children, chronic kidney disease tends to progress to end-stage renal failure, which is a major clinical problem. Systemic hypertension and glomerular hyperfiltration lead to progressive nephron damage. 1 – 3 Effective blood-pressure control delays the progression of renal disease in adults with chronic kidney disease, and antihypertensive agents that inhibit the renin–angiotensin system provide superior renoprotection, owing to their additional antiproteinuric, antiinflammatory, and antifibrotic properties. 4 – 7 Children comprise less than 1% of the total population with chronic kidney disease and often have congenital kidney malformations, urinary tract disorders, or genetic disorders that affect nephron formation or function. Hypertension . . .

• Publisher: Massachusetts Medical Society
• Subject: Adolescent / Angiotensin-Converting Enzyme Inhibitors - administration & dosage / Angiotensin-Converting Enzyme Inhibitors - adverse effects / Antihypertensive Agents - therapeutic use / Biological and medical sciences / Blood Pressure / Blood Pressure Monitoring, Ambulatory / Child / Child, Preschool / Creatinine - urine / Disease Progression / Drug Therapy, Combination / Female / General aspects / Glomerular Filtration Rate / Humans / Hypertension / Hypertension - drug therapy / Hypertension - etiology / Kaplan-Meier Estimate / Kidney diseases / Kidney Failure, Chronic - prevention & control / Male / Medical sciences / Nephrology. Urinary tract diseases / Nephropathies. Renovascular diseases. Renal failure / Pediatrics / Proteinuria - etiology / Ramipril - administration & dosage / Ramipril - adverse effects / Renal failure / Renal Insufficiency, Chronic - complications / Renal Insufficiency, Chronic - drug therapy / Renal Insufficiency, Chronic - physiopathology