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March 21, 2001

Complications

Question from New York, New York, USA:

Doctors usually suggest that people with diabetes should have their kidney function examined for any sign of the microalbuminuria at least once a year. Does this mean that it can be reversed or cured with ACE inhibitors if detected before it progresses over a maximum of one year? Can ACE inhibitors only delay its long-term progress to a more serious nephropathy including the renal failure? I think there is a big difference between reversing and simply delaying the progress of the disease. Can diabetic nephropathy can be cured if detected early enough?

Answer:

We think that microalbuminuria is a marker for increased risk of nephropathy. However, it is not established that microalbuminuria ends in chronic end-stage renal failure. Intervention studies using ACE inhibitors have shown that patients with microalbuminuria, who are treated with ACE inhibitors, have protection from long-term kidney function deterioration.

We do not yet have such information as it applies to patients with diabetes and no microalbuminuria. When the medications are instituted, I would titrate the medication to allow for normalization of the albumin excretion rate or until there are side effects of the medicine.

JTL