REDUCTION IN ALBUMINURIA PREDICTS A BENEFICIAL EFFECT ON DIMINISHING THE PROGRESSION OF HUMAN DIABETIC NEPHROPATHY DURING ANTIHYPERTENSIVE TREATMENT

Diabetic nephropathy is the main cause of increased mortality and morb idity in IDDM patients. The effect of antihypertensive treatment on th e progression of the nephropathy is highly variable. The aim of this s tudy was to evaluate putative predictors of the progression in diabeti c nephropathy during long-term antihypertensive treatment. Eighteen hy pertensive IDDM patients with diabetic nephropathy, who had not been t reated previously, were followed during 3 years of treatment with capt opril and frusemide or bendrofluazide. Glomerular filtration rate, art erial blood pressure, albuminuria and adjusted albuminuria were used a s putative predictors of rate of decline in glomerular filtration. Fal l rate in glomerular filtration rate was 4.6 (4.0) ml.min(-1).year(-1) (mean (SD)) during treatment. Relative change in albuminuria (ratio o f first year of treatment/baseline) and albuminuria during first year of treatment were significantly correlated to fall rate in glomerular filtration rate during 3 years of treatment (r = 0.73, p < 0.001) and (r = 0.60, p < 0.01), respectively. Arterial blood pressure and glomer ular filtration rate measured at baseline, during first year of treatm ent or relative changes in these variables did not correlate with fall rate in glomerular filtration rate during 3 years of treatment. Haemo globin A(1c), serum-cholesterol, protein intake and sodium excretion r emserum-cholesterol, protein intake and sodium excretion remained unch anged during treatment, and were not correlated with loss of kidney fu nction. Reduction in albuminuria during captopril treatment predicts a n attenuated rate of decline in glomerular filtration rate in early di abetic nephropathy (glomerular filtration rate > 70 ml.min(-1).1.73 m( -2)). The finding suggests a clinical application in monitoring the ef ficacy of antihypertensive treatment in early diabetic nephropathy.