• MeSH
• Blood Pressure Monitoring, Ambulatory * MeSH
• Antihypertensive Agents therapeutic use   MeSH
• Child MeSH
• Hypertension etiology   drug therapy   diagnosis   MeSH
• Hypertrophy, Left Ventricular * etiology   physiopathology   MeSH
• Blood Pressure * drug effects   MeSH
• Humans MeSH
• Adolescent MeSH
• Kidney Transplantation * adverse effects   MeSH
• Check Tag
• Child MeSH
• Humans MeSH
• Adolescent MeSH
• Male MeSH
• Female MeSH
• Publication type
• Letter MeSH
• Names of Substances
• Antihypertensive Agents MeSH

Arterial hypertension in renal transplant recipients warrants antihypertensive treatment. The preferable choice of antihypertensives that should be used in patients after kidney transplantation remains a matter of debate; however, calcium channel blockers (CCB) and angiotensin-converting enzyme inhibitors (ACEI) are currently the most commonly used antihypertensives. This educational review summarizes the current evidence about the effects of these two classes of medications in transplant recipients. Several studies have demonstrated that both classes of drugs can reduce blood pressure (BP) to similar extents. Meta-analyses of adult randomized controlled trials have shown that graft survival is improved in patients treated with ACEIs and CCBs, and that CCBs increase, yet ACEIs decrease, graft function. Proteinuria is usually decreased by ACEIs but remains unchanged with CCBs. In children, no randomized controlled study has ever been performed to compare BP or graft survival between CCBs and ACEIs. Post-transplant proteinuria could be reduced in children along with BP by ACEIs. The results of the most current meta-analyses recommend that due to their positive effects on graft function and survival, along with their lack of negative effects on serum potassium, CCBs could be the preferred first-line antihypertensive agent in renal transplant recipients. However, antihypertensive therapy should be individually tailored based on other factors, such as time after transplantation, presence of proteinuria/albuminuria, or hyperkalemia. Furthermore, due to the difficulty in controlling hypertension, combination therapy containing both CCBs and ACEIs could be a reasonable first-step therapy in treating children with severe post-transplantation hypertension.

• Keywords
• Angiotensin-converting enzyme inhibitors, Calcium channel blockers, Children, Graft function, Hypertension, Proteinuria, Renal transplantation,
• MeSH
• Antihypertensive Agents pharmacology   therapeutic use   MeSH
• Calcium Channel Blockers pharmacology   therapeutic use   MeSH
• Child MeSH
• Adult MeSH
• Hypertension * drug therapy   etiology   MeSH
• Angiotensin-Converting Enzyme Inhibitors pharmacology   therapeutic use   MeSH
• Blood Pressure drug effects   MeSH
• Humans MeSH
• Proteinuria drug therapy   etiology   MeSH
• Check Tag
• Child MeSH
• Adult MeSH
• Humans MeSH
• Publication type
• Journal Article MeSH
• Research Support, Non-U.S. Gov't MeSH
• Names of Substances
• Antihypertensive Agents MeSH
• Calcium Channel Blockers MeSH
• Angiotensin-Converting Enzyme Inhibitors MeSH

Proteinuria is a relatively frequent complication in children after renal transplantation (40-80 %). It is usually mild and non-nephrotic in nature and predominantly tubular in origin. The major causes of post-transplant proteinuria are recurrence of primary glomerulonephritis [mostly focal segmental glomerulosclerosis (FSGS)], rejection (acute and chronic), mTOR inhibitors or hypertension. Proteinuria is a risk factor for graft loss and patient death in adults, and even a mild proteinuria (0.1-0.2 g/day) is associated with impaired graft and patient survival. In children, proteinuria seems to be associated with graft but not patient survival. Proteinuria (protein/creatinine ratio) should be assessed regularly in all children. In children with prior chronic kidney disease due to idiopathic FSGS, proteinuria should be assessed daily during the first month after transplantation to enable early diagnosis of recurrence. The cause of proteinuria should be identified, and graft biopsy should be considered in children with unexplained proteinuria, especially with new onset proteinuria or deterioration of previously mild proteinuria. Treatment must be primarily targeted at the cause of proteinuria, and in normotensive children symptomatic antiproteinuric therapy with angiotensin-converting enzyme inhibitors/angiotensin II receptor antagonists should also be initiated. Other antihypertensive drugs should be used to achieve target blood pressure of <75th percentile. Target proteinuria should be <20 mg/mmol creatinine.

• MeSH
• Angiotensin Receptor Antagonists therapeutic use   MeSH
• Antihypertensive Agents therapeutic use   MeSH
• Time Factors MeSH
• Kidney Failure, Chronic diagnosis   etiology   surgery   MeSH
• Glomerulosclerosis, Focal Segmental complications   diagnosis   MeSH
• Hypertension complications   diagnosis   drug therapy   MeSH
• Immunosuppressive Agents adverse effects   MeSH
• Angiotensin-Converting Enzyme Inhibitors therapeutic use   MeSH
• Humans MeSH
• Graft Survival MeSH
• Proteinuria diagnosis   etiology   physiopathology   therapy   MeSH
• Recurrence MeSH
• Graft Rejection diagnosis   etiology   therapy   MeSH
• Renin-Angiotensin System drug effects   MeSH
• Risk Factors MeSH
• TOR Serine-Threonine Kinases antagonists & inhibitors   MeSH
• Kidney Transplantation adverse effects   MeSH
• Age Factors MeSH
• Treatment Outcome MeSH
• Check Tag
• Humans MeSH
• Publication type
• Journal Article MeSH
• Research Support, Non-U.S. Gov't MeSH
• Review MeSH
• Names of Substances
• Angiotensin Receptor Antagonists MeSH
• Antihypertensive Agents MeSH
• Immunosuppressive Agents MeSH
• Angiotensin-Converting Enzyme Inhibitors MeSH
• MTOR protein, human MeSH Browser
• TOR Serine-Threonine Kinases MeSH

Hypertension is a common and serious complication after renal transplantation. It is an important risk factor for graft loss and adverse cardiovascular outcomes. Blood pressure (BP) in transplanted children should be measured not only by clinic BP (cBP) measurement, but also by ambulatory blood pressure monitoring (ABPM), because ABPM has distinct advantages over cBP, specifically the ability to reveal nocturnal, masked or white-coat hypertension. These types of hypertension are common in transplanted children (nocturnal hypertension 36-71 %, masked hypertension 24-45 %). It may also reveal uncontrolled hypertension in treated children, thereby improving control of hypertension. Regular use of ABPM and ABPM-guided therapy of hypertension may help to decrease cardiovascular and renal target organ damage in transplanted children. Therefore, ABPM should be routinely performed in all transplanted children at least once a year, regardless of the values of cBP.

• MeSH
• Blood Pressure Monitoring, Ambulatory methods   MeSH
• Time Factors MeSH
• Child MeSH
• Hypertension diagnosis   MeSH
• Humans MeSH
• Masked Hypertension diagnosis   MeSH
• Postoperative Complications diagnosis   MeSH
• Graft Survival MeSH
• White Coat Hypertension diagnosis   MeSH
• Kidney Transplantation * MeSH
• Check Tag
• Child MeSH
• Humans MeSH
• Publication type
• Journal Article MeSH
• Research Support, Non-U.S. Gov't MeSH
• Review MeSH