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Kidney Diseases

ACE Inhibitor and Proteinuria

11/30/2011

Question:

My teenager just developed proteinuria. We don’t know yet if it`s persistent or transient, BUT, my oldest son - whom I`ve written to Dr. Lam about here in the past - also has both proteinuria and hypertension. His hypertension is under control on Lisinopril 20mg/daily and his proteinuria is currently very minimal (but still there). With my oldest having gone through extensive testing (including a renal biopsy) and no kidney disease having been uncovered, this remains a frustrating mystery and makes a parent feel quite helpless. I worry that my youngest now is going to develop hypertension as his brother did just a few years ago. If only we could figure out what`s going on! There is no kidney disease in the family that we know of. Both boys are tall, thin, athletic teens. If you could tell me how you might treat proteinuria in the absence of anything else but given this older sibling`s history, that would prepare me further to talk to the nephrologist. Can ACE Inhibitors be used to treat proteinuria in the absence of hypertension or is there some other recommended treatment? My oldest son had proteinuria – what had been diagnosed as orthostatic via 24-hr. tests – for YEARS before his hypertension emerged. I want to make sure we’re doing everything we can to protect my younger son’s kidneys NOW and maybe head off hypertension altogether. Thank you for sharing your time and expertise.

Answer:

Hi, I assume that you are the one who wrote the letters in 2009 and 2010 about your son who reportedly had TBM on biopsy, but no hematuria?  It certainly is interesting that his brother now also has proteinuria.  Even though orthostatic proteinuria is not a genetic disorder, I think this is still the most likely diagnosis, considering that he is also a tall, thin guy.  He will still probably need a renal biopsy eventually.  But in the meantime, an ACE inhibitor can definitely be used to reduce the proteinuria and protect the kidneys even if he is not hypertensive.  Again, as with his brother, this may be two separate, unrelated diseases, orthostatic proteinuria and familial/genetic hypertension.   

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Response by:

Mildred   Lam, MD Mildred Lam, MD
Associate Professor of Medicine
School of Medicine
Case Western Reserve University