When should we start and stop ACEi/ARB in paediatric chronic kidney disease?
Aldosterone
Angiotensin Receptor Antagonists
/ adverse effects
Angiotensin-Converting Enzyme Inhibitors
/ adverse effects
Antihypertensive Agents
/ pharmacology
Child
Disease Progression
Humans
Hyperkalemia
Mineralocorticoid Receptor Antagonists
Renal Insufficiency, Chronic
/ drug therapy
Renin
Renin-Angiotensin System
/ drug effects
Angiotensin receptor blocker
Angiotensin-converting enzyme inhibitor
Blood pressure
Children
Chronic kidney disease
Proteinuria
RAAS inhibition
Journal
Pediatric nephrology (Berlin, Germany)
ISSN: 1432-198X
Titre abrégé: Pediatr Nephrol
Pays: Germany
ID NLM: 8708728
Informations de publication
Date de publication:
07 2021
07 2021
Historique:
received:
21
07
2020
accepted:
15
09
2020
revised:
19
08
2020
pubmed:
16
10
2020
medline:
22
12
2021
entrez:
15
10
2020
Statut:
ppublish
Résumé
Renin-angiotensin-aldosterone inhibitors (RAASi) are the mainstay therapy in both adult and paediatric chronic kidney disease (CKD). RAASi slow down the progression of kidney failure by optimization of blood pressure and reduction of proteinuria. Despite recommendations from published guidelines in adults, the evidence related to the use of RAASi is surprisingly scarce in children. Moreover, their role in advanced CKD remains controversial. Without much guidance from the literature, paediatric nephrologists may discontinue RAASi in patients with advanced CKD due to apparent worsening of kidney function, hyperkalaemia and hypotension. Current data suggest that this strategy may in fact lead to a more rapid decline in kidney function. The optimal approach in this clinical scenario is still not well defined and there are varying practices worldwide. We will in this review describe the existing evidence on the use of RAASi in CKD with particular focus on paediatric data. We will also address the use of RAASi in advanced CKD and discuss the potential benefits and harms. At the end, we will suggest a practical approach for the use of RAASi in children with CKD based on current state of knowledge.
Identifiants
pubmed: 33057769
doi: 10.1007/s00467-020-04788-w
pii: 10.1007/s00467-020-04788-w
doi:
Substances chimiques
Angiotensin Receptor Antagonists
0
Angiotensin-Converting Enzyme Inhibitors
0
Antihypertensive Agents
0
Mineralocorticoid Receptor Antagonists
0
Aldosterone
4964P6T9RB
Renin
EC 3.4.23.15
Types de publication
Journal Article
Review
Langues
eng
Sous-ensembles de citation
IM
Pagination
1751-1764Références
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