Background:In pediatric patients with nephrotic syndrome (NS) treated with steroid, addition of Angiotensin Converting Enzyme Inhibitor (ACEi) or Angiotensin Receptor Blocker (ARB) or combination of ACEi and ARB is performed to reduce proteinuria. However, the use of ACEi+ARB combination in adult with hypertension has been known to induce hypotension, hyperkalemia, and increase of creatinine serum. Objective:This study aimed to compare the effectiveness and safety of ACEi+ARB combination or ACEi alone as antiproteinuric therapy in pediatrics with frequent relapse NS (FRNS) or steroid-dependent NS (SDNS).Materials and Methods: A retrospective cohort study using data from medical record of pediatrics with FRNS or SDNS at the Cipto Mangunkusumo Hospital between 2014 to 2018 was conducted. Effectiveness parameters were the onset of achieving negative proteinuria and the proportion of patients with negative proteinuria within 4 weeks of treatment. Safety parameters were the incidence of hypotension, hyperkalemia, increased of serum creatinine, and decrease of glomerular filtration rate. Results: Out of 63 patients with SSNS or SDNS evaluated, ACEi+ARB were given to 33 patients, and ACEi alone to 30 patients. There was no significant difference in the onset of negative proteinuria between the two groups (median 3 weeks in ACEi+ARB vs 4 weeks in ACEi,  p=0.125). A total of 24 patients (72.7%) in the ACEi+ARB group and 19 patients (63.3%) in the ACEi group achieved negative proteinuria within 4 weeks (RR: 1.148, 95% CI: 0.815-1.619, p=0.424). There were no significant differences between ACEi+ARB and ACEi groups in the occurrence of hypotension, hyperkalemia, increased of creatinine serum, and decreased of glomerular filtration rate.Conclusions: The effectiveness and the safety of ACEi+ARB vs ACEi alone as antiproteinuric therapy in pediatric patients with FRNS or SDNS are similar.  ACEi alone is sufficient as an add-on antiproteinuric in such conditions.

Keywords:pediatric,  frequent relaps nephrotic syndrome, ACEi, ARB, antiproteinuric