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Renal Function in Glycogen Storage Disease Type I, Natural Course, and Renopreservative Effects of ACE Inhibition

Daniëlle H. J. Martens^*, Jan Peter Rake, Gerjan Navis, Vaclav Fidler, Catharina M. L. van Dael^||, and G. Peter A. Smit^*

^* Department of Pediatrics, University Medical Center Groningen, Groningen, The Netherlands; Department of Pediatrics, Martini Hospital Groningen, Groningen, The Netherlands; Department of Nephrology, University Medical Center Groningen, Groningen, The Netherlands; Department of Epidemiology, University Medical Center Groningen, Groningen, The Netherlands; ^|| Department of Pediatric Nephrology, University Medical Center Groningen, Groningen, The Netherlands

Correspondence: Dr. Daniëlle H. J. Martens,University Medical Center Groningen, Department of Pediatrics, Hanzeplein 1, PO Box 30 001, 9700 RB Groningen, The Netherlands. Phone: 31-50-3614147; Fax: 31-50-3611704; E-mail d.h.j.martensj{at}bkk.umcg.nl

Background and objectives: Renal failure is a major complication in glycogen storage disease type I (GSD I). We studied the natural course of renal function in GSD I patients. We studied differences between patients in optimal and nonoptimal metabolic control and possible renoprotective effects of angiotensin converting enzyme inhibition.

Design, setting, participants, & measurements: Thirty-nine GSD I patients that visited our clinic were studied. GFR and effective renal plasma flow (ERPF) were measured by means of I¹²⁵ iothalamate and I¹³¹ hippuran clearance and corrected for body surface area. Microalbuminuria was defined as >2.5 mg albumin/mmol creatinine and proteinuria as >0.2 g protein per liter. Optimal metabolic control was present when blood glucoses were >3.5 mmol/L, urine lactate/creatinine ratios <0.06 mmol/mmol, triglycerides <6.0 mmol/L, and uric acid concentrations <450 µmol/L.

Results: Quadratic regression analysis showed a biphasic pattern in the course of GFR and ERPF related to age. Microalbuminuria was observed significantly less frequently in the patients with optimal metabolic control compared with the patients with nonoptimal metabolic control. A significant decrease in GFR was observed after starting ACE inhibition.

Conclusions: This study describes a biphasic pattern of the natural course of GFR and ERPF in GSD I patients, followed by the development of microalbuminuria and proteinuria. Optimal metabolic control has a renoprotective effect on the development of microalbuminuria and proteinuria in GSD I patients. Treatment with ACE inhibitors significantly decreases the GFR, especially in GSD I patients with glomerular hyperfiltration.