Diabetic nephropathy in children and adolescents: a critical review with particular reference to angiotensin-converting enzyme inhibitors |
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Authors: | F Chiarelli A Casani A Verrotti G Morgese L Pinelli |
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Affiliation: | Department of Paediatrics, Universities of Chieti, Italy;Department of Siena, Universities of Chieti, Italy;Department of Verona, Universities of Chieti, Italy |
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Abstract: | Clinical diabetic nephropathy is a well-recognized cause of increased morbidity and mortality in patients with type 1 diabetes. The finding that microalbuminuria predicts progression to overt nephropathy has allowed early diagnosis and preventive interventions. Several studies have demonstrated that treatment with angiotensin-converting enzyme (ACE) inhibitors slows down the rate of decline of the glomerular filtration rate in type 1 diabetes patients with established proteinuria. The renoprotective properties of the ACE inhibitor captopril extend beyond its antihypertensive effects. ACE inhibitors represent the most appropriate class of antihypertensive drugs for treating type 1 diabetes patients because of their efficacy and safety. When microalbuminuria is detected and confirmed in a diabetic child or adolescent, and if it persists despite 6-12 months of improved metabolic control, treatment with ACE inhibitors should be started, even if the child is normotensive. Careful follow-up of renal function is essential. |
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Keywords: | Angiotensin-converting enzyme inhibitors diabetic nephropathy microalbuminuria preventive interventions type 1 diabetes |
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