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  • Title: Persistent renin-angiotensin system activation after anti-reflux surgery and its management.
    Author: Bajpai M, Bal CS, Kumar R, Chaturvedi PK, Kalaivani M, Gupta AK.
    Journal: J Pediatr Urol; 2011 Dec; 7(6):616-22. PubMed ID: 21807561.
    Abstract:
    PURPOSE: To study renin-angiotensin system activation and the role of angiotensin-converting enzyme inhibition (ACE-I) after anti-reflux surgery. MATERIAL AND METHODS: Thirty nine children underwent anti-reflux surgery for high grades of primary VUR. Plasma renin activity (PRA), urinary microalbumin, renal scars, split renal function (SRF), glomerular filtration rate (GFR), serum creatinine, blood pressure and episodes of breakthrough urinary tract infection were monitored in the early (5.9 ± 3.9; range 3-9 months) and late (27.1 ± 6.5; range 15-36 months) postoperative phase, before and after therapy with ACE-I (mean period 13.6 ± 2.5; range 10-24 months). RESULTS: The early postoperative improvement in renal parameters (rise in SRF and GFR by 11.2% and 7.3%, respectively, and fall in PRA by 68.8%), was not sustained subsequently (minimal improvement in SRF, 7.4%, and GFR, 0.14%, was accompanied by a rise in PRA by 92.3%). After ACE-I therapy, improvement was noted in SRF and GFR by 0.5% and 7.5%, respectively, and there was a fall in urinary microalbumin by 52.3%. CONCLUSIONS: Significant down regulation of rennin-angiotensin system activation and the accompanying improvement in renal function seen early after surgery is not sustained during follow up. ACE-I aids renal recovery.
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