USE OF INHIBITORS OF ANGIOTENSIN CONVERTING ENZYME IN CHILDREN WITH KIDNEY DISEASES

Abstract

THE AIM of the work was to study the state of hemodynamics at different levels of renal arterial system and the influence of inhibitors of angiotensin converting enzyme (ACE) on hemodynamic indices in children with glomerulonephrites (GN). PATIENTS AND METHODS. In 74 children with different variants of glomerulonephritis inhibitor of ACE Enap (Enalapril) in daily dose 0.1 0.3 mg/kg was used in addition to traditional medicine. RESULTS. According to data of impulse dopplerometry the state of renal blood flow in GN was impaired at different levels of the renal arterial system (in the trunk of the renal artery, segmentary, interlobular and arcuate arteries). The most pronounced disorders in dynamics were observed in small arteries of the kidneys interlobular and, especially, arcuate. But blood flow in large arteries can remain normal. In the edematic period of the nephrotic form (NF) of GN disorders in the renal blood flow are characterized by higher indices of vascular resistance in the renal artery trunk first of all, and in most patients it was combined with edema of parenchyma and increased sizes of the kidneys. Improvement of renal hemodynamics and substantially decreased proteinuria was obtained by administration of Enap (daily dose 0.1 mg/kg) while in nephrogenic AH effective was the daily dose of Enap not less than 0.3 mg/kg. Administration of inhibitors of ACE for NF of chronic GN was followed by a considerable improvement of indices of impulse dopplerometry at all levels of the renal artery, decrease of high arterial pressure. Using Enap facilitated effective drop of high arterial pressure in most patients examined. CONCLUSION. Thus, most children with GN have marked disorders of renal hemodynamics that can often be corrected by ACE inhibitors.