The aim of the study was to evaluate the effects of early treatment with the angiotensin-converting enzyme inhibitor, enalapril, on the blood pressure and left ventricular diameters and function in children suffering from acute postinfectious glomerulonephritis.
Patients and methods: A total of 51 children with acute postinfectious glomerulonephritis were involved in the study. Out of them, 26 patients were treated with enalapril for 6 weeks, 25 patients served as their controls. Their blood pressure was measured every other day in the early course of the disease, after 6-8 weeks, and after 6 months. 2D, M-mode, pulsed-wave Doppler echocardiography were performed on 18 enalapril treated patients and 14 controls on admission to the hospital and after 6-8 weeks.
Results: An earlier decline in blood pressure was found in the enalapril treated patients, with no difference between the groups at 6 months after onset of acute postinfectious glomerulonephritis. Comparison of the echocardiographic findings at the onset of acute postinfectious glomerulonephritis and after 6-8 weeks of enalapril treatment showed a significant decrease of left ventricular end-diastolic diameter (4.42+/-0.71 cm before treatment vs. 4.19+/-0.69 after treatment, p<0.001), left ventricular end-systolic diameter (2.81+/-0.59 cm vs. 2.64+/-0.48 cm, respectively, p=0.04), left ventricular mass (102.56+/-51.86 g vs. 86.77+/-43.54 g, p<0.001), and mitral peak flow velocity of late filling (0.54+/-0.11 m/s vs. 0.49+/-0.09 m/s, p=0.02). Other parameters, although statistically nonsignificant, showed better improvement in the enalapril treated patients than in those untreated. In the enalapril untreated group, echocardiographic parameters did not change significantly.
Conclusion: A better antihypertensive effect was found in the enalapril treated patients, as well as better improvement of echocardiographic parameters, early in the disease. Whether these effects of enalapril have some influence on the outcome of acute postinfectious glomerulonephritis requires further study.