F. Inserra et al., DECREASE OF EXERCISE-INDUCED MICROALBUMINURIA IN PATIENTS WITH TYPE-IDIABETES BY MEANS OF AN ANGIOTENSIN-CONVERTING ENZYME-INHIBITOR, American journal of kidney diseases, 27(1), 1996, pp. 26-33
Taking into account both the importance of microalbuminuria (MA) as a
predictive parameter of clinical nephropathy in diabetic patients and
the efficiency of exertion to show and/or to increase MA in both diabe
tic patients and normal individuals, we studied 37 type I diabetic pat
ients divided into two groups: group A, with no MA at rest (n = 19), a
nd group B, with MA at rest (n = 18). Group C comprised 10 healthy vol
unteers as controls. Changes of basal MA during exercise and postexerc
ise were studied in all three groups. Normotensive patients with no me
tabolic disorders, normal renal function, and no proteinuria underwent
an ergometric test up to 600 kg. This test was repeated after the adm
inistration of 20 mg enalapril in a single daily dose for 60 days. Bod
y weight, systolic and diastolic arterial pressure, creatinine, and cr
eatinine clearance were determined and showed no significant variation
s either between groups or with treatment. Microalbuminuria was studie
d in the three groups with and without administration of enalapril thr
oughout the 2 months of the study. Determinations were performed under
conditions of rest, exercise, and postexercise. Mean baseline MA valu
es +/- SEM were as follows: at rest, 5.22 +/- 0.49, 58.36 +/- 13.24, a
nd 4.73 +/- 0.45 mu g/min for groups A, B, and C, respectively; with e
xercise, 15.19 +/- 4.43, 74.70 +/- 14.89, and 16.76 +/- 4.62 mu g/min
for groups A, B, and C, respectively; and postexercise, 32.04 +/- 6.64
, 253.15 +/- 63.88, and 9.23 +/- 3.25 mu g/min, respectively. The geom
etric means of the baseline to posttreatment MA ratio were as follows:
at rest, 0.95, 1.59 (P < 0.01), and 1.03 for groups A, B, and C, resp
ectively; with exercise, 1.53 (P < 0.01), 1.91 (P < 0.01), and 1.69 fo
r groups A, B, and C, respectively; and postexercise, 2.94 (P < 0.01),
3.24 (P < 0.01), and 1.03 for groups A, B, and C, respectively. In co
nclusion, in the early diagnostic suspicion of diabetic nephropathy, t
he screening of postexercise MA during an ergometric test could be of
help. Treatment with enalapril decreased MA in diabetic groups A (no M
A at rest) and B (MA at rest) during exercise and postexercise, and al
so decreased MA in group B while at rest. (C) 1996 by the National Kid
ney Foundation, Inc.