Effectiveness and safety of the angiotensin II antagonist irbesartan in children with chronic kidney diseases

• Published in: American journal of hypertension Vol. 15; no. 12; pp. 1057 - 1063
• Main Authors: Franscini, Lorenzo M.D., Von Vigier, Rodo O., Pfister, Roger, Casaulta-Aebischer, Carmen, Fossali, Emilio, Bianchetti, Mario G.
• Format: Journal Article
• Language: English
• Published: New York, NY Elsevier Inc 01.12.2002; Oxford University Press; Elsevier Science
• Subjects: Adolescent; Angiotensin Receptor Antagonists; Antihypertensive agents; Antihypertensive Agents - therapeutic use; Biological and medical sciences; Biphenyl Compounds - therapeutic use; Blood Pressure; Cardiovascular system; Child; Child, Preschool; childhood; chronic kidney disease; Cyclosporine - therapeutic use; Drug Interactions; Female; Humans; hypertension; Hypertension - complications; Hypertension - drug therapy; Immunosuppressive Agents - therapeutic use; Irbesartan; Kidney Failure, Chronic - complications; Kidney Failure, Chronic - therapy; Linear Models; Male; Medical sciences; Pharmacology. Drug treatments; Prospective Studies; proteinuria; Proteinuria - etiology; Renal Dialysis; Tetrazoles - therapeutic use; Treatment Outcome; chronic kidney disease; Irbesartan; childhood; hypertension; proteinuria; Human; Kidney disease; Hypertension; Tetrazole derivatives; Urinary system disease; Toxicity; Treatment efficiency; Cardiovascular disease; Chemotherapy; Chronic; Treatment; Biphenyl derivatives; Renal failure; Antihypertensive agent; Arterial pressure; Child; Proteinuria
• DOI: 10.1016/S0895-7061(02)03083-2
• ISSN: 0895-7061

Studies in adults with chronic kidney diseases demonstrate that the orally available angiotensin II antagonist irbesartan reduces arterial pressure and pathological proteinuria, mostly with an excellent tolerability profile. Little information is available on irbesartan in childhood. A total of 44 pediatric outpatients with chronic kidney disease (27 male and 17, aged 3.7 to 18 years, median 10 years) were given irbesartan once a day during 18 weeks for arterial hypertension ( N = 23), proteinuria ( N = 8), or both ( N = 13). In patients with hypertension, the use of irbesartan 4.1 (3.1–5.3) mg/kg body weight daily (median and interquartile range) was associated with a decrease ( P < .005) in arterial pressure by 17 (13–22)/10 (7–12) mm Hg. In patients with overt proteinuria the urinary protein excretion decreased ( P < .01) during treatment with irbesartan (2.9 [2.0–4.8] mg/kg body weight) by 52 (0–75) mg/[m 2 × h]), whereas plasma albumin increased ( P < .05) by 4 (1–5) g/L. The frequency of abdominal pain, constipation, cough, diarrhea, dizziness, edema, fatigue, headache, insomnia, myalgia, orthostasis, and rash was similar before and with irbesartan. Plasma sodium slightly decreased, whereas plasma potassium increased, with irbesartan ( P < .01). In pediatric patients with chronic kidney diseases, irbesartan given once a day for 18 weeks significantly reduces arterial pressure and proteinuria, with an excellent tolerability and side effect profile.