Efetividade do tratamento com inibidores da enzima conversora de angiotensina isolados e/ou associados à hidroxiureia em pacientes pediátricos com nefropatia falciforme: uma revisão sistemática

Abstract

Sickle cell disease (SCD) is one of the most prevalent hereditary diseases in the world and currently has a longer life expectancy due to improvements in diagnosis and treatment. Sickle cell nephropathy (NF), which begins in childhood, is a frequent complication in these patients. This systematic review (SR) analyzes the effectiveness of using angiotensin-converting enzyme (ACE) inhibitors in children with NF. Randomized clinical studies with participants between zero and 18 years of age and NF, whose intervention was treatment with ACE inhibitors, were included. Of the 6,560 studies selected, only one met the inclusion criteria, which made it impossible to carry out a meta-analysis. There was a reduction in microalbuminuria (MA) in the intervention group, greater than in the placebo group, over a 3-month period. It is not possible to determine the degree of certainty about the efficacy of lisinopril compared to placebo in pediatric NF due to the lack of meta-analysis and the risk of bias in the study. Therefore, new randomized and controlled clinical studies of medications with a protective or reducing effect on renal complications in pediatric patients are necessary, given that renal impairment in SCD begins in childhood and with significant morbidity and mortality in adult patients.