Use of Angiotensin Converting Enzyme Inhibitors for the Treatment of Focal Segmental Glomerulosclerosis

Sir.—Angiotensin converting enzyme (ACE) inhibitors have been shown to limit proteinuria and preserve renal function in adult patients with chronic renal insufficiency.^1-4 Recent data by Trachtman and Gauthier⁵ demonstrated that short-term captopril therapy reduced urinary protein excretion in children with nephrotic range proteinuria of varying origins.

We reviewed charts of all patients less than 21 years of age who have been seen at The Children's Hospital of The Cleveland (Ohio) Clinic Foundation between January 1981 and October 1989 with a diagnosis of either nephrotic syndrome or asymptomatic proteinuria. Patients with biopsyproved focal segmental glomerulosclerosis were identified and categorized as having nephrotic syndrome as defined by the International Study of Kidney Disease in Children⁶ or proteinuria without the other manifestations of nephrotic syndrome. We chose this disease because of its resistance to usual therapy and progression to renal insufficiency. The following characteristics of the patients were analyzed: