HOME HELP FEEDBACK SUBSCRIPTIONS ARCHIVE SEARCH TABLE OF CONTENTS		QUICK SEARCH:   [advanced] Author: Keyword(s): Year:  Vol:  Page:

This Article Full Text Full Text (PDF) All Versions of this Article: CJN.03691106v1 2/3/461    most recent Alert me when this article is cited Alert me if a correction is posted Citation Map Services Email this article to a friend Similar articles in this journal Similar articles in PubMed Alert me to new issues of the journal Download to citation manager Citing Articles Citing Articles via HighWire Citing Articles via Google Scholar Google Scholar Articles by Ficociello, L. H. Articles by Krolewski, A. S. Search for Related Content PubMed PubMed Citation Articles by Ficociello, L. H. Articles by Krolewski, A. S. Related Collections Related Article

Determinants of Progression from Microalbuminuria to Proteinuria in Patients Who Have Type 1 Diabetes and Are Treated with Angiotensin-Converting Enzyme Inhibitors

Linda H. Ficociello^*, Bruce A. Perkins^*,,, Kristen H. Silva^*, Dianne M. Finkelstein^,, Halina Ignatowska-Switalska^||, Zbigniew Gaciong^||, L. Adrienne Cupples^¶, Ann Aschengrau^¶, James H. Warram^*, and Andrzej S. Krolewski^*,

^* Research Division, Joslin Diabetes Center, Department of Medicine, Harvard Medical School, Massachusetts General Hospital Cancer Center, and ^¶ School of Public Health, Boston University, Boston, Massachusetts; Division of Endocrinology and Metabolism, University of Toronto, Toronto, Ontario, Canada; and ^|| Division of Internal Medicine and Hypertension, Warsaw Medical University, Warsaw, Poland

Address correspondence to: Dr. Andrzej S. Krolewski, Section on Genetics & Epidemiology, Joslin Diabetes Center, One Joslin Place, Room 368, Boston, MA 02215. Phone: 617-732-2668; Fax: 617-732-2667; E-mail: andrzej.krolewski{at}joslin.harvard.edu

The aims of this study were to assess the frequency and determinants of (1) treatment with angiotensin-converting enzyme inhibitors (ACE-I) and (2) progression to proteinuria in the presence of ACE-I treatment in patients with type 1 diabetes and microalbuminuria. A clinic-based cohort study of patients with type 1 diabetes was begun in 1991. The patients who were included in this study (n = 373) are the cohort members who received a diagnosis of microalbuminuria during a 2-yr baseline observation and were followed for 10 yr with frequent assessments of urinary albumin excretion and biennial examinations. Progression to proteinuria occurred when the median urinary albumin excretion during a 2-yr interval exceeded 299 µg/min. During the decade-long study, the proportion of patients who had a history of microalbuminuria and were treated with ACE-I rose from 17 to 67%. Patients who started this treatment had (on average) higher BP, higher urinary albumin excretion, and longer diabetes duration than those who did not. Microalbuminuria often progressed to proteinuria (6.3/100 person-years) in those who were treated. Poor glycemic control and elevated serum cholesterol were the major determinants/predictors of this progression. Although treatment with ACE-I increased during the past decade, it was not completely effective, because microalbuminuria progressed to proteinuria in many treated patients. Poor glycemic control and elevated serum cholesterol were the major determinants/predictors for progression while on ACE-I treatment. The mechanisms that are responsible for the frequent failure of ACE-I to prevent progression of microalbuminuria to proteinuria in a clinical setting are not clear.

Related Article

Treating Diabetic Nephropathy: Unfinished Success Is Not Failure

Julia Lewis
Clin. J. Am. Soc. Nephrol. 2007 2: 407-409. [Full Text] [PDF]

This article has been cited by other articles:

				G. Schernthaner Kidney disease in diabetology: lessons from 2008 Nephrol. Dial. Transplant., February 1, 2009; 24(2): 396 - 399. [Full Text] [PDF]

				M. A. Niewczas, L. H. Ficociello, A. C. Johnson, W. Walker, E. T. Rosolowsky, B. Roshan, J. H. Warram, and A. S. Krolewski Serum Concentrations of Markers of TNF{alpha} and Fas-Mediated Pathways and Renal Function in Nonproteinuric Patients with Type 1 Diabetes Clin. J. Am. Soc. Nephrol., January 1, 2009; 4(1): 62 - 70. [Abstract] [Full Text] [PDF]

				V. P. Singh, B. Le, R. Khode, K. M. Baker, and R. Kumar Intracellular Angiotensin II Production in Diabetic Rats Is Correlated With Cardiomyocyte Apoptosis, Oxidative Stress, and Cardiac Fibrosis Diabetes, December 1, 2008; 57(12): 3297 - 3306. [Abstract] [Full Text] [PDF]

				Z. Zhang, Y. Zhang, G. Ning, D. K. Deb, J. Kong, and Y. C. Li Combination therapy with AT1 blocker and vitamin D analog markedly ameliorates diabetic nephropathy: Blockade of compensatory renin increase PNAS, October 14, 2008; 105(41): 15896 - 15901. [Abstract] [Full Text] [PDF]

				E. T. Rosolowsky, L. H. Ficociello, N. J. Maselli, M. A. Niewczas, A. L. Binns, B. Roshan, J. H. Warram, and A. S. Krolewski High-Normal Serum Uric Acid Is Associated with Impaired Glomerular Filtration Rate in Nonproteinuric Patients with Type 1 Diabetes Clin. J. Am. Soc. Nephrol., May 1, 2008; 3(3): 706 - 713. [Abstract] [Full Text] [PDF]