The safety of fosinopril treatment in pediatric chronic kidney disease:a controlled trial

Objective To evaluate the safety of fosinopril treatment for chronic kidney disease(CKD)in children.Methods Cases with peadiatric CKD(SRNS and IgA nephropathy)whose proteinuria(DPL)was over 50 mg·kg-1·d-1 were recruited from February,2008 to August,2009 in Guangzhou Children's Hospital.Subjects were divided into middle dose treatment group(group1),lower dose treatment group(group 2),and control group(group 3).Group 1 was treated with basic therapies combined with 0.3 mg·kg-1·d-1 Fos;Group 2 was treated with basic therapies combined with 0.1 mg·kg-1·d-1 Fos;Group 3 was treated with basic therapies,respectively.Basic therapies were defined as prednisone oral administration combined with large-dose medrol ictus treatment.The patients were recorded regularly for DPL,potassium,Scr,Ccr,blood pressure,liver funtion and blood cell count at 0,2,4,8,12,16,20,24 week,then the data were analyzed by conventional methods.When adverse effect occurred,Fos treatment was stopped.Results After treatment,mean arterial pressure levels of middle dose group and low dose group decreased obviously compared with that before treatment(P0.05).Compared with control group,the mean arterial pressure levels of group 1 and group 2 differed from each other significantly(P0.05).The patients treated with Fos were divided into hypertension and normal blood presure groups at the start of the study.At ending point the mean arterial pressure dropped significantly from(73.9±2.8)mmHg to(79.7± 8.4)mmHg in hypertension group(P 0.05),and the normal blood pressure group did not change obviously(P0.05).The potassium and SCr levels of groups 1 and 2 with fosinopril treatment were still normal at the end of study,whereas potassium levels of the two groups were elevated significantly than before treatment.SCr levels of group 1 was higher than the control group(P0.05)at the second week.Although the elevation of the CCr level appeared in the first two weeks,the difference was not statistically significant between pre-treatment and after treatment(P0.05).During the study,the blood cell and liver function remained stable,and no case appeared cough and angioedema etc.Conclusions 0.3 mg·kg-1·d-1 fosinopril is safe and tolerable treatment for children with CKD.