Anaemia after Enalapril in a Child with Nephrotic Syndrome

Abstract

A girl aged 7 years with focal segmental glomerulosclerosis and nephrotic syndrome failed to respond to prednisolone for 7 weeks, and to prednisolone with cyclophosphamide for a further 8 weeks Blood pressure was normal and oedema was controlled with diuretics Creatinine had increased from 30 μmol/L to 50 μmol/L, and the urine protein/creatinine ratio from 2400 mg/mmol to 4000 mg/mmol From week 10 to week 40, creatinine rose from 30 μmol/L to 85 μmol/L and the urine albumin/creatinine ratio fluctuated between 2000 mg/mmol and 4000 mg/mmol She was started on enalapril 2·5 mg twice daily After 3 months, enalapril was discontinued because her haemoglobin had fallen from 127 g/L to 62 g/L with haematocrit of 0·16, but with normal ferritin, folate, and vitamin B12 There is a relation between onset of anaemia and use of enalapril (figure) A weaker relation was seen with prednisolone withdrawal.