High Rate of Regression From Micro-Macroalbuminuria to Normoalbuminuria in Children and Adolescents With Type 1 Diabetes Treated or Not With Enalapril

Abstract

OBJECTIVETo evaluate the frequency of normalization, the persistence of remission, and the impact on normalization of glycemic control and lipid profile, we analyzed data from a retrospective observational cohort study of type 1 diabetic children and adolescents with abnormal urinary albumin excretion (UAE).RESEARCH DESIGN AND METHODSAll diabetic children and adolescents (n = 41) who had persistent abnormal UAE in the period of 1984 to 2008 and followed up until 2009 (follow-up duration = 13.1 ± 6.2 years) were included in the study. Nine patients progressed to macroalbuminuria; 24 patients were administered ACE inhibitor treatment.RESULTSThe cumulative prevalence of abnormal UAE was 9%. During follow-up, 14 of 17 untreated and 19 of 24 treated patients reverted to normoalbuminuria. In the remission group compared with the nonremission group, A1C levels during follow-up decreased (7.5 ± 1.0 vs. 9.4 ± 1.2%, P < 0.0001) and serum HDL cholesterol increased (52.7 ± 11.3 vs. 42.7 ± 8.6 mg/dL, P < 0.05). The micro-macroalbuminuric patients had lower HDL cholesterol (51.0 ± 11.4 vs. 62.4 ± 13.6 mg/dL, P < 0.0001) than 134 normoalbuminuric diabetic patients.CONCLUSIONSMicroalbuminuria and macroalbuminuria were not permanent in most of our diabetic children and adolescents. If abnormal UAE values are high and persist for >1 year, only long-lasting treatment with ACE inhibitors seems able to induce persistent remission, especially when associated with good metabolic control and high HDL cholesterol levels.

Natural course of untreated microalbuminuria in children and adolescents with type 1 diabetes and the importance of diabetes duration and immigrant status: longitudinal analysis from the prospective nationwide German and Austrian diabetes survey DPV

“…In the present survey, regression rate of persistent microalbuminuria to intermittent microalbuminuria or normoalbuminuria without ACE inhibitor treatment was estimated at 71.2%. This percentage is comparable to a recently published, small study, where 14 out of 17 patients (82% of patients) who had never received ACE inhibitors underwent spontaneous remission during a follow-up period of 13.1G6.2 years (36). Many studies have examined risk factors including glycaemic control, diabetes duration, sex, smoking, hypertension and disturbed lipid metabolism to determine and predict diabetic nephropathy (1,2,3,4,5,6,35,37).…”

“…Furthermore, other studies showed that abnormal lipid profiles are risk factors for the development of microalbuminuria (36,39). Especially, lower HDL-cholesterol levels are present in patients with type 1 diabetes and microalbuminuria (36). However, and in contrast to those studies, we did not observe such an effect.…”

“…The small number of patients with poor metabolic control in the present survey possibly explains the reason why we did not observe a significant association between HbA1c levels and the presence of microalbuminuria. Furthermore, other studies showed that abnormal lipid profiles are risk factors for the development of microalbuminuria (36,39). Especially, lower HDL-cholesterol levels are present in patients with type 1 diabetes and microalbuminuria (36).…”

“…Some longitudinal studies have suggested that more than 50% of cases with persistent microalbuminuria in adolescence revert to normoalbuminuria at the end of puberty (4,11,13). However, in many longitudinal studies, a certain number of patients do receive treatment with antihypertensive drugs (4,11,12,17,33,34,35,36). For instance, in the Oxford regional prospective study, cumulative prevalence of regression to normoalbuminuria was 51.9% after w5 years after the onset of microalbuminuria (33).…”

Zalecenia Sekcji Pediatrycznej Polskiego Towarzystwa Nadciśnienia Tętniczego dotyczące postępowania diagnostycznego i terapeutycznego w nadciśnieniu tętniczym u dzieci i młodzieży

“…Although, renal failure in diabetic kidney disease usually occurs after many years of disease, the early stages of diabetic kidney disease characterized by increased albuminuria are observed also in the paediatric population [110][111][112][113]. In adolescents kidney damage in T1DM is directly related to elevated BP values, and effective antihypertensive treatment slows the progression of kidney damage [114].…”