Renin-angiotensin-aldosterone system inhibitors in pediatric focal segmental glomerulosclerosis

Pediatr Nephrol. 2012 May;27(5):813-9. doi: 10.1007/s00467-011-2056-x. Epub 2011 Nov 25.


Background: Conventional immunosuppressive therapy for primary pediatric focal segmental glomerulosclerosis (FSGS) is potentially toxic and only moderate evidence supports its effectiveness. Renin-angiotensin-aldosterone (RAAS) inhibition monotherapy is anecdotally used in selected patients as an alternative to conventional therapy.

Methods: We performed a retrospective cohort study of children with primary FSGS seen at a tertiary care academic hospital between 1986 and 2008. We classified patients into two groups based upon initial treatment: RAAS inhibition monotherapy (RIM) and conventional therapy (CT). The primary endpoint was progression to end-stage renal disease (ESRD). Secondary endpoints were remission of proteinuria, relapse, and death.

Results: The cohort consisted of 67 patients. Mean baseline urine protein/creatinine ratio (Up/c) was 8.0 (5.2, 10.7) mg/mg, and mean baseline estimated glomerular filtration rate (eGFR) was 115.0 (101.8, 128.1) mL/min/1.73 m(2). Patients in the RIM group were more likely to have lower eGFR (100.8 mL/min/1.73 m(2) vs 132.9 mL/min/1.73 m(2), p = 0.01) and less proteinuria (4.4 vs.14.4, p < 0.01). Renal failure occurred in 22.9% of the RIM group vs 40.6% in the CT group (log-rank p = 0.07). After adjustment for African-American race, time period of presentation, baseline age, eGFR, and Up/c, patients in the RIM group had a 0.11 hazard ratio of progressing to renal failure compared with patients in the CT group (p < 0.01).

Conclusions: Children treated initially with RIM may have better outcomes than those treated with CT.

MeSH terms

  • Adolescent
  • Blood Pressure
  • Child
  • Cohort Studies
  • Female
  • Glomerular Filtration Rate
  • Glomerulosclerosis, Focal Segmental / drug therapy*
  • Humans
  • Immunosuppressive Agents / therapeutic use
  • Kaplan-Meier Estimate
  • Kidney Function Tests
  • Male
  • Proteinuria / etiology
  • Renal Insufficiency / etiology
  • Renin-Angiotensin System / drug effects*
  • Retrospective Studies
  • Survival Analysis
  • Treatment Outcome


  • Immunosuppressive Agents