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Randomized Controlled Trial
. 2009 Apr;4(4):820-9.
doi: 10.2215/CJN.02810608.

Prospective change in renal volume and function in children with ADPKD

Melissa A Cadnapaphornchai  1 , Kim McFann, John D Strain, Amirali Masoumi, Robert W Schrier
Affiliations
Randomized Controlled Trial

Prospective change in renal volume and function in children with ADPKD

Melissa A Cadnapaphornchai et al. Clin J Am Soc Nephrol. 2009 Apr.

Abstract

Background and objectives: Autosomal dominant polycystic kidney disease (ADPKD) is a progressive hereditary disorder affecting children and young adults. Early intervention may be necessary to significantly affect the long-term consequences of this disease.

Design, setting, participants, & measurements: The authors conducted a 5-yr randomized clinical trial to assess the effect of BP control with angiotensin-converting enzyme inhibition (ACEI) on disease progression in 85 children and young adults with ADPKD. Study groups were determined by subject BP, including hypertension (BP >or= 95th percentile), borderline hypertension (BP 75 to 95th percentile), and severe ADPKD (BP <or=75th percentile with > 10 renal cysts). The primary outcome variable was renal volume by ultrasound, with secondary outcome variables including left ventricular mass index (LVMI) and microalbuminuria. In secondary analysis, the authors compared results between hypertensive and normotensive groups.

Results: The authors were not able to demonstrate a significant effect of ACEI on renal growth in young subjects with ADPKD. Hypertensive children were at particular risk for increases in renal volume and LVMI and decreased renal function as compared with the other study groups, and borderline hypertensive children were at high risk to develop hypertension over time. However, ACEI treatment was associated with stable renal function and LVMI in this group of children.

Conclusions: Close monitoring of cardiovascular and renal status is indicated in ADPKD children with hypertension or borderline hypertension. In contrast to effects in hypertensive ADPKD children, ACEI treatment in normotensive or borderline hypertensive ADPKD children may prevent the development of increased LVMI and deterioration in renal function.

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Figures

Figure 1.
Figure 1.
Flow of participants through study.
Figure 2.
Figure 2.
Hypertensive (HBP, n = 28) children had consistently higher renal volume than normotensive (NBP, n = 57) children throughout the 5-yr study period. Values are geometric mean (95% confidence interval) adjusted for height and sex. For HBP versus NBP: *P < 0.0001; **P < 0.0002.
Figure 3.
Figure 3.
Relationship between renal volume and age in children with ADPKD who were (A) hypertensive; (B) normotensive.
Figure 4.
Figure 4.
Hypertensive (HBP) subjects had higher left ventricular mass index (LVMI) at baseline as compared with normotensive (NBP) subjects with ADPKD. No significant differences in LVMI were noted between the groups at year 5 of study. Values are geometric mean (95% confidence interval) adjusted for height and sex. For HBP versus NBP: *P < 0.005; **P < 0.05. For NBP Year 0 versus Year 5: P̂ < 0.0002.
See this image and copyright information in PMC

Comment in

References

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