The role of ACE inhibitor in reducing persistent proteinuria in nephrotic syndrome

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Erika Hutabarat
Husein Alatas
Sri Rezeki Hadinegoro


Background Patients with persistent proteinuria are at risk for progression to end-stage renal failure. Angiotensin converting enzyme inhibitor (ACEI) can decrease proteinuria in nephrotic syndrome (NS) patients with persistent proteinuria.

Objective To evaluate the effectiveness of ACEI (enalapril) in reducing proteinuria in NS.

Methods This study was conducted as a randomized double blind clinical trial with crossover design on persistent proteinuria NS patients who visited Cipto Mangunkusumo Hospital from December 2000 until July 2001. Twenty patients were enrolled in this study. Ten patients received enalapril 10 mg/day for 8 weeks and ten patients received placebo. Angiotensin converting enzyme inhibitor as considered effective if proteinuria was reduced for at least 50%.

Results The patients aged between 2-16 years with a mean of 11.3 years and consisted of 16 boys and 4 girls with a ratio of 4:1. Urine protein and creatinine ratio (Up/Uc) was used to evaluate proteinuria. In the ACEI group, the mean value of proteinuria increased

trom5.6 (95%CI 1.1 ;2.2)to 6.7 (95%CI 0.3;13.2) (p=0.721),  although it decreased in five patients. Decreased proteinuria to 50%or more was found in 2 out of 10 patients in the enalapril group while in the placebo group it was found in 3 out of 10, but this differences was not statistically significant (,0=0.5). Systolic blood pressure decreased significantly (p=0.0185) from 107 mmHg (95%CI 101.1;112.9 mmHg) to 103 mmHg (95%CI 96.2;109.8 mmHg) although still in nonnal range.

Conclusions The efficacy of enalapril in reducing proteinuria could not be evaluated yet. A further study with greater sample and longer observation is needed.

Article Details

How to Cite
Hutabarat E, Alatas H, Hadinegoro S. The role of ACE inhibitor in reducing persistent proteinuria in nephrotic syndrome. PI [Internet]. 31Dec.2002 [cited 22Nov.2019];42(11-12):243-. Available from:
Received 2016-11-15
Accepted 2016-11-15
Published 2002-12-31


1. Millner OS, Morgenstem BZ. ACE inhibitors for reduction of proteinuria in children with steroid-resisrtant nephrotic syndrome. Pediatr Nephrol. 1991;55:87-90.
2. Bohlen L, de Cour:ten M, Weidmann P. Comparative study of the effect of ACE-inhibitors and other anti-hypercensive agents on proteinutia in diabetic patients, Arnl Hypertens 1994;7:845-945.
3. Taguma Y, Kitammo Y, Fmaki G, Veda H, Monma H, Tshizaki M, et al. Effect of captopril on heavy proteinuria in azotemic diabetics, New Engl J Med 1985;313:1617-20.
4. Trachtman H, Gauthier B. Effect of ACE inhibitor therapy on proteinuria in children with renal disease. J Pedlatr 1988;112:295-8.
5. Houser M, Assessment of proteinuria using random urine samples. J Pediatr 1984;104:845-8.
6. Bergstein JM, A practical approach to proteinuria. Pediatr NephroI. 1999;13:697-700.
7. Opie LH, ACE inhibitors: side effect and contraindications. In: Opie LH, editor. Angiotensin convertingg enzyme inhibitors. Scientific basis for clinical use. 2nd ed. New York: Wiley-Liss; 1994. p.218-27.
8. Erley CM, liaerer LJ, Krame BK, Risler T. Renal hemodynamic and reduction of proteinuria by a vasodilating beta-blocker versus an ACE inhibitor. Kidney Int .1992;41: 1297-303.
9. Schwartz GJ, Haycock GB, Edelmann CM, Spitzer A. A simple estimate of glomerular filtration rate in children derived from body length and plasma creatinine. Pediatrics 1976;58:259-63.
10. de Cotret PR. Proteinuria, microalbuminuria and the role of ACE inhibitors. The Can J Diagn. Suppl 1996;4:11-4.
11. Keane WF, Elnoyan G. Proteinuria, albuminuria, risk, assessment, detection, elimination (PARADE): a position paper of the National Kidney Foundation. Am J Kidney Dis 1999;33:1004-10.
12. Yoshida A, Morozumi K, Takeda A, Koyama K, Ideura T, Ikeda M, et al. The effect of enalapril on proteinuria in patients with chronic glomerulonephritis and renal insufficiency [abstract]. Nippon Jinzo Gakkai Shi. 1993; 35:1249-52.
13. Delucchi A, Cano F, Rodriguez E, Wolff E, Gonzalez X, Cumsille MA. Enalapril and prednisone in children with nephritic-range proteinuria. Pediatr Nephrol 2000;14:1088-91.
14. Shiigai T, Shichiri M. Late escape from the antiproteinuric effect of ACE inhibitors in non-diabetic renal disease. Am J Kidney Dis 2001;37:477-83.
15. Lama G, Luongo I , Piscitelli A, Salsano ME. Enalapril: antiproteinuric effect in children with nephrotic syndrome [abstract]. Clin Nephrol. 2000;53:432-6.
16. Kamper AL, Sttangaard S, Leysaac PE Effect of enalapril on the progression of chronic renal failure, A randomized controlled trial. Am J Hypertens 1992;5:42:l-l0.
17. Ruggenenti P, Mosconi L, Vendramin G, Moriggi M, Remuzzi A, Sangalli F, et al. at. ACE inhibition improves glomerular size selectivity in patients with idiopathic membranous nephropathv and persistent nephritic syndrome. Am J Kidney Dis 2000;35:381-91.
18. Thomas OM, Hillis AN, Coles GA, Davies M, Williams JD. Enalapril can treat the proteinuria of membranous glomerulonephritis without detriment to systemic or renal hemodynamics. Am J Kidney Dis 1991;18:38-43.
19. Wita Wirya IGN. Sindrom nefrotik. In: Alatas H, Tambunan T, Trihono PP, editors. Buku ajar Nefrologi Anak. 2nd ed. Jakarta: Balai Penerbit FKUI; 2002. p.381-426.