Initial decrease in proteinuria after institution of ACE inhibitor treatment predicts long term prognosis for kidney function in overt diabetic nephropathy
ASN 30th Annual Meeting, San Antonio
J Am Soc Nephrol (Sep) 8:117A 1997
15 patients with diabetic nephropathy and decreased GFR were treated with enalapril for 4.4 (3.5-5.5) yrs. GFR-adjusted albumin excretion decreased from 28 µg/ml/1.73 m2 to 11 µg/ml/1.73 m2 during the first 6 mo of therapy. Patients with the largest decrease in GFR-adjusted albuminuria (i.e., > 50%) had virtually no subsequent decline in renal fucntion as opposed to an approximately 5 ml/min/yr decline in GFR in the remaining patients. The authors conclude that initial reduction in proteinuria predicts the long- term course of overt diabetic nephropathy.
Comment: This is a small study but the results are provocative. It suggests that the long-term prognosis in diabetic nephropathy can be predicted by short-term antiproteinuric response to ACE inhibitors. If confirmed, not only would this be useful in patient management but would give credence to short-term clinical trials using proteinuria as a marker of renoprotective effects. (David J. Leehey, M.D., Loyola University at Chicago)
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ASN 30th Annual Meeting, San Antonio
Proteinuria/Hematuria : Diabetes
CRF by problem area : Progression