A Cochrane review [Abstract] 1 included 56 studies with a total of 2 838 subjects. The antihypertensives examined were predominantly angiotensin-converting enzyme inhibitors (ACEi), angiotensin receptor blockers (ARB) or combinations of both. With ACEi or ARB versus placebo/no treatment, proteinuria decreased (mean difference -0.73, 95% CI -1.06 to -0.39; 3 trials, n=197) and creatinine clearance increased (MD 6.97; 95% CI -0.60 to 14.54; 3 trials, n=197). When ACEi was compared with ARB there were no significant differences for the outcomes: serum creatinine, creatinine clearance, proteinuria, and proteinuria change. There is no evidence that treatment affects major renal and/or cardiovascular endpoints or long-term mortality risk beyond the benefit that arises from controlling hypertension. The evidence is insufficient to demonstrate efficacy for any of the other therapies (fish oil, anticoagulant, tonsillectomy, statins, herbal medicine) evaluated here.
A meta-analysis 2 included 5 RCTs involving 295 patients. ACEI/ARB agents reduced proteinuria (standardized mean differences [SMD], -0.46; 95% CI -0.64 to -0.27; P < 0.00001; heterogeneity I ²=35%) and blood pressure. No significant difference was found on serum creatinine (SMD, -3.51; 95% CI -16.55 to 9.54; P = 0.60; heterogeneity I ²=0%; P = 0.74) and GFR (SMD, 2.59; 95% CI, -7.14 to 12.33; P = 0.60; heterogeneity I ²=57%; P = 0.10).
A systematic review 3 included 8 studies with a total of 737 children. 202 used ACEI/ARB and were compared with placebo and other therapy regimens. Of the 7 studies that evaluated proteinuria, 6 reported an efficacy of ACEI/ARB in reducing this marker. ACEI/ARB also showed a possible effect in reducing hematuria and oxidative stress.
Comment: The quality of evidence is downgraded by risk of bias (unclear blinding).
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