Renin angiotensin aldosterone inhibitors in the treatment of proteinuria in children with congenital anomalies of the kidney and urinary tract: more evidence needed

Introduction: Congenital anomalies of the kidney and urinary tract (CAKUT) can be associated with proteinuria, possibly leading to a decline in kidney function. The aim of this review is to evaluate evidence on the efficacy of renin-angiotensin-aldosterone system inhibitors (RAASi) in children affected by CAKUT with proteinuria or chronic kidney disease (CKD). Areas covered: We conducted a bibliographic search between 1 December 2022 and 20 February 2023, including randomized controlled trials, case-control studies, observational studies, meta-analyses, and systematic reviews dealing with the efficacy of RAASi in reducing proteinuria and slowing the decline of kidney function in children. Expert opinion: RAASi are effective in reducing proteinuria and slowing CKD progression in many renal conditions; however, the efficacy of these drugs in patients affected by CAKUT with proteinuria is still unknown. While waiting for more evidence, when facing a child with CAKUT with isolated proteinuria or with proteinuria and CKD, a 6-12-month trial with RAASi with gradual increase to the maximal tolerated dose should be considered. If no improvement of proteinuria is obtained, the RAASi should be discontinued.

Automated summary

This review evaluates the efficacy of RAASi in treating proteinuria and CKD in children with CAKUT. While RAASi has shown effectiveness in reducing proteinuria and slowing CKD progression in many renal conditions, its efficacy in CAKUT patients is still uncertain. Therefore, a trial period of 6-12 months with gradual increase of RAASi dosage should be considered for CAKUT children with isolated proteinuria or proteinuria and CKD, and discontinuation of RAASi should be considered if no improvement in proteinuria is seen.