Key points are not available for this paper at this time.
Background and objectives We showed that mineralocorticoid receptor blockade (MRB) prevented acute and chronic cyclosporine nephropathy (CsA-Nx) in the rat. The aim of this translational study was to investigate the effect of long-term eplerenone administration on renal allograft function in children with biopsy-proven chronic allograft nephropathy (CAN). Design, setting, participants, at 24 months it was 66±8 and 81±7 ml/min per 1.73 m 2 , respectively ( P =0.33; 95% confidence intervals, −18 to 33 at baseline, and −11 to 40 after 24 months). The albumin-to-creatinine ratio was 110±74 in the placebo, and 265±140 mg/g in the eplerenone group; and after 24 months it was 276±140 and 228±88 mg/g, respectively ( P =0.15; 95% confidence intervals, −283 to 593, and −485 to 391, respectively). In addition, the placebo exhibited a greater TIF, glomerulosclerosis, and urinary HSP72 compared with the eplerenone group. Conclusions Although this study was underpowered to provide definitive evidence that long-term eplerenone administration attenuates the progression of CAN in pediatric transplant patients, it encourages testing the potential benefit of MRB in this pediatric population.
Medeiros-Domingo et al. (Tue,) studied this question.