Significance of this study: Angiotensin II converting enzyme inhibitor therapy has been shown to reduce protein excretion in several forms of glomerular disease. This diminution of protein excretion occurs in the presence and absence of systemic hypertension. In several experimental models of glomerular injury and progressive renal failure, glomerular hypertension is present in the absence of an elevated systemic arterial pressure. In most experimental models of renal injury, angiotensin II converting enzyme inhibitor therapy decreases glomerular hypertension, urinary protein excretion, and glomerular injury. In human studies the data are most compelling in patients with diabetic nephropathy. It is reasonably certain that glomerular hypertension plays a role in the pathogenesis of experimental diabetic nephropathy, and angiotensin II converting enzyme inhibitor therapy has a salutary effect. Several short term (<3 months), and long term (>6 months) studies have demonstrated that angiotensin II converting enzyme inhibitors reduce systemic blood pressure and proteinuria in diabetic patients. This therapy reduces proteinuria independent of the initial blood pressure or degree of pre-existing renal dysfunction. From our short term prospective trial, we know that an angiotensin II converting enzyme inhibitor is capable of reducing proteinuria in patients with sickle cell nephropathy for a short interval. An important question not answered by this short term study is whether or not angiotensin II converting enzyme inhibitor therapy, by reducing glomerular capillary hypertension, can ameliorate proteinuria for an extended time. An even more important question is whether or not angiotensin II converting enzyme inhibitor therapy can retard the progressive decline in renal function in sickle cell disease patients with renal insufficiency. Therefore, the questions that we wish to answer in the current study are whether the long term administration of an angiotensin II converting enzyme inhibitor in patients with sickle cell nephropathy: 1) prevents or retards the development of renal insufficiency, and 2) reduces proteinuria on a long term basis. Patients will be treated with either Enalapril or placebo. The primary outcome variable will be a change in the glomerular filtration rate. We have 13 patients at Duke who remain on the protocol. Fifteen patients initially enrolled in the study, with one withdrawn by physicians owing to an presumed idiosyncratic reaction to the drug (back pain), and one patient who withdrew from the study. As anticipated, the entire patient population is African-American.
| Askie, Lisa M; Darlow, Brian A; Finer, Neil et al. (2018) Association Between Oxygen Saturation Targeting and Death or Disability in Extremely Preterm Infants in the Neonatal Oxygenation Prospective Meta-analysis Collaboration. JAMA 319:2190-2201 |
| Srinivasan, Lakshmi; Page, Grier; Kirpalani, Haresh et al. (2017) Genome-wide association study of sepsis in extremely premature infants. Arch Dis Child Fetal Neonatal Ed 102:F439-F445 |
| Denson, Lee A; McDonald, Scott A; Das, Abhik et al. (2017) Early Elevation in Interleukin-6 is Associated with Reduced Growth in Extremely Low Birth Weight Infants. Am J Perinatol 34:240-247 |
| James, Jennifer; Munson, David; DeMauro, Sara B et al. (2017) Outcomes of Preterm Infants following Discussions about Withdrawal or Withholding of Life Support. J Pediatr 190:118-123.e4 |
| Younge, Noelle; Goldstein, Ricki F; Bann, Carla M et al. (2017) Survival and Neurodevelopmental Outcomes among Periviable Infants. N Engl J Med 376:617-628 |
| Archer, Stephanie Wilson; Carlo, Waldemar A; Truog, William E et al. (2016) Improving publication rates in a collaborative clinical trials research network. Semin Perinatol 40:410-417 |
| Ahmed, Zuhayer; Prasad, Indrajit; Rahman, Hafizur et al. (2016) A Male with Extreme Subcutaneous Insulin Resistance: A Case Report. Rom J Diabetes Nutr Metab Dis 23:209-213 |
| Phelps, Dale L; Ward, Robert M; Williams, Rick L et al. (2016) Safety and pharmacokinetics of multiple dose myo-inositol in preterm infants. Pediatr Res 80:209-17 |
| Barroso, Julie; Leserman, Jane; Harmon, James L et al. (2015) Fatigue in HIV-Infected People: A Three-Year Observational Study. J Pain Symptom Manage 50:69-79 |
| Stafford-Smith, Mark; Li, Yi-Ju; Mathew, Joseph P et al. (2015) Genome-wide association study of acute kidney injury after coronary bypass graft surgery identifies susceptibility loci. Kidney Int 88:823-32 |
Showing the most recent 10 out of 128 publications
