A Cochrane review [Abstract] 1 included 80 studies with a total of 4 856 subjects. The antihypertensives examined were predominantly angiotensin-converting enzyme inhibitors (ACEi), angiotensin receptor blockers (ARB) or combinations of both. Compared to placebo or no treatment, renin-angiotensin system (RAS) inhibition decread proteinuria (MD - 0.71 g/24 h, 95% CI -1.04 to -0.39; 3 studies, n=199) but may result in little or no difference to kidney failure or doubling of serum creatinine (SCr), or complete remission of proteinuria. When ACEi was compared with ARB there were no significant differences for the outcomes: serum creatinine, creatinine clearance, proteinuria, and proteinuria change. Death, remission of proteinuria or haematuria, or relapse of proteinuria were not reported.
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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