Iraqi Postgraduate Medical Journal

Abstract

ABSTRACT:
BACKGROUND:
Nephrotic syndrome is primarily a pediatric disorder which causes heavy proteinuria , hypoalbuminemia , edema, and hyperlipidemia. Most children (90%) with nephrotic syndrome have idiopathic nephrotic syndrome caused in 85% of the patients by minimal change glomerular disease.
Valsartan is an angiotensin II receptor blocker approved in adults for the treatment of hypertension, heart failure and it may also reduce proteinuria in nephritic syndrome.
OBJECTIVE:
The aims of this study are to assess antiproteinuric effect of valsartan in nephrotic syndrome in comparison with propranolol and captopril , and to assess safety of valsartan in pediatric age.
PATIENTS AND METHODS:
A case control study was done for 104 patients who attended three pediatric hospitals ( The Central Pediatric Hospital, Al- Elwyia Pediatric Hospital and Ibn Al-Baladi Hospital) where they were newly diagnosed with minimal change nephrotic syndrome and 38 of them (36.5%) were diagnosed with hypertension from 2006 to 2013 and they were followed up for six
months (course of disease treatment). Data collected in this study included: age, sex, time of diagnosis and blood pressure was measured. Laboratory tests were done which include: measurement of blood urea, serum creatinine, serum potassium , serum cholesterol, serum albumin, hemoglobin level, liver enzymes (serum glutamate pyruvate transaminase, serum glutamic-oxaloacetic transaminase and serum alkaline phosphatase ) and albumin in urine.
RESULT:
Despite comparable reduction in blood pressure among the 3 groups, angiotensin receptor blocker-treated group showed statistically more significant reduction in proteinuria (amount and onset after initiation of therapy) than other groups.
Drug-related adverse events were minor and infrequent, no patient developed dangerous increase in serum potassium, renal function and liver function parameters nor dangerous decrease in mean hemoglobin level.
CONCLUSION:
Valsartan is an effective and safe drug to be used in childhood minimal chang nephrotic syndrom with rapid and consistent antiproteinuric effect even beyond its antihypertensive effect.