Sickle Cell Disease
Conditions
Keywords
Angiotensin-converting enzyme inhibitors (ACE), Renal disease, Microalbuminemia
Brief summary
Patients with sickle cell anaemia may develop renal disease. In fact, renal disease occurred in 40% of adults patients (macroalbuminuria) with evolution to end-stage renal disease for half of them. Microalbuminuria is an early and sensitive marker of glomerular damage. It appears during the first decade and occurred in 20 to 25% of infants (2 to 18 years). Physiopathology of renal scarring is not well understood actually. Renal scarring might be due to glomerular hyperfiltration and vascular and endothelial damage. Angiotensin-converting enzyme inhibitors (ACE) were studied and used in diabetic nephropathy. In a study on 26 sickle cell adults, albuminuria was reduced about 50% by ACE compared to placebo after six months treatment. It might be interesting studying ACE efficacy in sickle cell children with microalbuminuria because renal disease is directly related to sickle cell and is not influenced by other cardiovascular risk factors like in adult patients. We hypothesized to have a successful ACE treatment in more than 40% of cases after a nine months treatment period. A success is defined as a 50% reduction of the albuminuria/creatinuria ratio.
Detailed description
This is a multicenter study. In order to include 72 patients we should pre-include 400 patients. They will be included in the study after signing the protocol consent. For final inclusion in the study, two albuminuria/creatinuria ratio should be over or equal to 3mg/mmol. If so, inclusion will be done and patient will be randomized (placebo/enalapril) by CLEANWEB software. A blood sample will be done. Treatment tolerance will be check up at day 7 (blood sample for renal tolerance and clinical examination), month 1(clinical examination), month 3(clinical examination), month 6(clinical examination), and month 9 (clinical examination). Treatment efficacy will be evaluated by albuminuria/creatinuria ratio at month 1, month 3, month 6, and month 9. Physiopathology of ACE efficacy will be studied at first day and month 9 by dosage of ICAM-1 and VCAM-1. Treatment plain posology (0.5mg/kg/day) will be progressively obtained on a three months period, beginning at 0.2mg/kg/day.
Interventions
DRUGEnalapril
* during 1 month : 0,2 mg/kg/day * then during 2 months (if no adverse event): 0,35 mg/kg/day * and then during 6 months (if no adverse event): 0,5 mg/kg/day
DRUGPlacebo
Glucose
Sponsors
Assistance Publique - Hôpitaux de Paris
Study design
Allocation
RANDOMIZED
Intervention model
PARALLEL
Primary purpose
TREATMENT
Masking
TRIPLE (Subject, Caregiver, Investigator)
Eligibility
Sex/Gender
ALL
Age
2 Years to 18 Years
Healthy volunteers
No
Inclusion criteria
* Sickle cell disease (SS, SC, Sb thalassemia, SD Punjab) * Affiliation to French Health benefits * Signed informed consent * Albuminemia / Creatinemia \>= 3 mg / mmol (on 2 samples)
Exclusion criteria
* Albuminemia / Creatinemia \> 100 mg / mmol * Hypersensibility to enalapril * Angio-oedemas due to a previous treatment by ACE * idiopathic or hereditary angio-oedemas * cerebral echo-doppler * treatment by lithium digoxine * treatment by other ACE * congenital galactosemia * Pregnancy
Design outcomes
Primary
| Measure | Time frame | Description |
|---|---|---|
| Percentage of successful treatment of each arm | at 9 months of treatment | Successful treatment is defined by a reduction by half of the albuminuria/ creatinuria ratio (mg / mmol). |
Secondary
| Measure | Time frame |
|---|---|
| Measure of albuminuria/ creatinuria ratio | at 1, 3 and 6 month of treatment. |
| Dosage of circulating forms of cell adhesion molecules ICAM-1 and VCAM-1 | at the first day and at 9 months of treatment. |
Countries
France
Outcome results
None listed