Childhood Kidney Diseases

Korean Society of Pediatric Nephrology (대한소아신장학회)
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Efficacy and safety of losartan in childhood immunoglobulin A nephropathy: a prospective multicenter study

  • Hyesun Hyun (Department of Pediatrics, St. Vincent's Hospital, College of Medicine, The Catholic University of Korea) ;
  • Yo Han Ahn (Department of Pediatrics, Seoul National University College of Medicine) ;
  • Eujin Park (Department of Pediatrics, Hallym University Kangnam Sacred Heart Hospital) ;
  • Hyun Jin Choi (Department of Pediatrics, Seoul National University College of Medicine) ;
  • Kyoung Hee Han (Department of Pediatrics, Jeju National University College of Medicine) ;
  • Jung Won Lee (Department of Pediatrics, Ewha Womans University School of Medicine) ;
  • Su Young Kim (Department of Pediatrics, Pusan National University Children's Hospital) ;
  • Eun Mi Yang (Department of Pediatrics, Chonnam National University Hospital, Chonnam National University Medical School) ;
  • Jin Soon Suh (Department of Pediatrics, Bucheon St. Mary's Hospital, College of Medicine, The Catholic University of Korea) ;
  • Jae Il Shin (Department of Pediatrics, Yonsei University College of Medicine) ;
  • Min Hyun Cho (Department of Pediatrics, School of Medicine, Kyungpook National University) ;
  • Ja Wook Koo (Department of Pediatrics, Inje University Sanggye Paik Hospital) ;
  • Kee Hyuck Kim (Department of Pediatrics, NHIC Ilsan Hospital) ;
  • Hye Won Park (Department of Pediatrics, Seoul National University Bundang Hospital) ;
  • Il Soo Ha (Department of Pediatrics, Seoul National University College of Medicine) ;
  • Hae Il Cheong (Department of Pediatrics, Hallym University Sacred Heart Hospital) ;
  • Hee Gyung Kang (Department of Pediatrics, Seoul National University College of Medicine) ;
  • Seong Heon Kim (Department of Pediatrics, Seoul National University College of Medicine)
  • Received : 2023.03.09
  • Accepted : 2023.10.06
  • Published : 2023.12.31
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Abstract

Purpose: Angiotensin-converting enzyme inhibitors and angiotensin II receptor blockers (ARBs) are frequently employed to counteract the detrimental effects of proteinuria on glomerular diseases. However, the effects of ARBs remain poorly examined in pediatric patients with immunoglobulin A (IgA) nephropathy. Herein, we evaluated the efficacy and safety of losartan, an ARB, in pediatric IgA nephropathy with proteinuria. Methods: This prospective, single-arm, multicenter study included children with IgA nephropathy exhibiting proteinuria. Changes in proteinuria, blood pressure, and kidney function were prospectively evaluated before and 4 and 24 weeks after losartan administration. The primary endpoint was the difference in proteinuria between baseline and 24 weeks. Results: In total, 29 patients were enrolled and received losartan treatment. The full analysis set included 28 patients who received losartan at least once and had pre- and post-urinary protein to creatinine ratio measurements (n=28). The per-protocol analysis group included 22 patients who completed all scheduled visits without any serious violations during the study period. In both groups, the mean log (urine protein to creatinine ratio) value decreased significantly at 6 months. After 24 weeks, the urinary protein to creatinine ratio decreased by more than 50% in approximately 40% of the patients. The glomerular filtration rate was not significantly altered during the observation period. Conclusions: Losartan decreased proteinuria without decreasing kidney function in patients with IgA nephropathy over 24 weeks. Losartan could be safely employed to reduce proteinuria in this patient population. ClinicalTrials.gov trial registration (NCT0223277)

Keywords

Acknowledgement

This research was supported by a grant (14172MFDS178) from the Ministry of Food and Drug Safety in 2014.

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