ESPN 50th Annual Meeting

ESPN 2017


 
Changes in urinary angiotensinogen after treatment with renin-angiotensin system blockade in pediatric chronic kidney disease patients with low birth weight
NATSUMI YAMAMURA-MIYAZAKI 1 TOSHIMI MICHIGAMI 1 KAORI FUJIWARA 1 KENICHI SATOMURA 1 MAKI URUSHIHARA 2 SHOJI KAGAMI 2 KATSUSUKE YAMAMOTO 1

1- DEPARTMENT OF PEDIATRIC NEPHROLOGY AND METABOLISM, OSAKA WOMENS AND CHILDRENS HOSPITAL
2- DEPARTMENT OF PEDIATRICS, INSTITUTE OF BIOMEDICAL SCIENCES, TOKUSHIMA UNIVERSITY GRADUATE SCHOOL
 
Introduction:

Children born with low birth weight (LBW) have higher risk of developing chronic kidney disease (CKD) because of a low number of nephrons. Some develop proteinuria and decreased renal function as early as childhood. However, no effective therapy has been established to suppress the progression of CKD in children with LBW. Renin-angiotensin system (RAS) activation plays a critical role in the development of hypertension and CKD, and our previous work demonstrated that urinary angiotensinogen (uAGT) is a useful marker of intrarenal RAS activation. The aim of this study was to assess whether treatment with RAS blockade is beneficial for suppressing the progression of CKD in children with LBW using uAGT as a surrogate marker.

Material and methods:

We recruited 11 children with LBW who were started on RAS blockade with Candesartan between April 2013 and August 2016 to treat hypertension or proteinuria. The mean birth weight was 797.8±282.6 g, and the mean age at evaluation was 13.8±3.5 years. We compared uAGT, blood pressure, urinary protein, serum electrolytes, and renal function before and after treatment with Candesartan.

Results:

After treatment with Candesartan for 20.7±13.0 months, the uAGT to urinary creatinine ratio was significantly decreased (56.9±41.9 vs. 8.2±5.5 μg/g, p=0.003). Urinary protein was also significantly decreased (p=0.003), although there were no significant changes in blood pressure, serum sodium and potassium, or estimated glomerular filtration rate based on serum creatinine.

Conclusions:

These data indicate that treatment with Candesartan suppresses the activation of the intrarenal RAS and reduces proteinuria, which may slow the progression of CKD in children with LBW. Further studies with a larger number of patients and longer observation of renal function are required.