A randomized trial of captopril for microalbuminuria in normotensive adults with sickle cell anemia.

University Hospital, Pointe-à-Pitre, Guadeloupe, French West Indies.
The American Journal of Medicine (Impact Factor: 5.3). 04/1998; 104(4):339-42. DOI: 10.1016/S0002-9343(98)00056-4
Source: PubMed

ABSTRACT Nephropathy is a common complication of sickle cell anemia and is often preceded by proteinurea. Our aim was to evaluate the effect of angiotensin-converting enzyme inhibition on microalbuminuria in sickle cell patients.
We performed a randomized, double-blind, placebo-controlled trial in 22 normotensive patients with sickle cell anemia and persistent microalbuminuria. Patients received captopril (25 mg/day) or placebo and were followed up for 6 months. Albuminuria, blood pressure, and serum creatinine and hemoglobin concentrations were measured at baseline and at 1, 3, and 6 months. The primary outcome variable was the 6-month change in albuminuria between the two groups.
Baseline albuminuria was 121 (SD 66) mg per 24 hours in the captopril group and 107 (SD 86) mg per 24 hours in the placebo group. Microalbuminuria decreased from baseline in the captopril group but increased in the placebo group. The mean absolute change and the mean percentage change in microalbuminuria were significantly different between the two groups at 6 months (absolute change -45 mg per 24 hours in the captopril group versus +18 mg per 24 hours in the placebo group, P <0.01; and percentage change -37% in the captopril group versus +17% in the placebo group, P <0.01). The 95% confidence intervals (CI) for the difference in albuminuria between the two groups were 63 (CI 40 to 86) mg per 24 hours for the mean absolute change and 54% (CI 22% to 85%) for the mean percentage change. Blood pressure decreased slightly from baseline in captopril-treated patients and did not change in the placebo group. The change was significantly different between the two groups only for diastolic blood pressure at 6 months (P <0.01).
Captopril reduces albuminuria and slightly decreases blood pressure in patients with sickle cell anemia. More studies are required to demonstrate the sustained benefit on protein excretion.

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    • "Proteinuria is more commonly encountered in patients with homozygous (hemoglobin SS) sickle cell disease than in other hemoglobinopathies [6]. Patients with HbSC had also been noted to develop renal insufficiency later than patients with HbSS [19]. A prospective study by Powars et al. showed that severe anaemia, hypertension, proteinuria, nephrotic syndrome, and microscopic hematuria were found to be significant predictor of chronic renal failure [20]. "
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    • "Microalbuminuria could be detected long before positive urine test for proteinuria using conventional dipstick like Albustix or Combi 10 Multistix screen which is sensitive to urinary protein excretion that is greater or equals to 300 mg/L [14]. Prolonged period of microalbuminuria precedes persistent proteinuria which is subsequently followed by chronic renal failure (CRF) [15] and occurs with variable frequency in the sickle cell population (4%–20%) [11]. "
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    • "Albuminuria, expressed as mg/ml of urine albumin level, was classified as normoalbuminuria (albumin b 20 mg/ml), microalbuminuria (albumin level from 20 to 200 mg/ml) and macroalbuminuria (albumin N 200 mg/ml). Since patients with either macroalbuminuria or pronounced microalbuminuria included in this study were under antihypertensive treatments which are known to decrease albumin excretion rate [6] [7] [8], urine albumin levels retained for the analysis were those recorded prior to such treatments. "
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