Effects of perindopril on renal histomorphometry in diabetic subjects withmicroalbuminuria: A 3-year placebo-controlled biopsy study

We conducted a 3-year randomized placebo-controlled double-blind study to d etermine the effects of the angiotensin-converting enzyme (ACE) inhibitor p erindopril (PE) on the progress of renal function and histology in subjects with diabetes end microalbuminuria. Forty non-insulin-dependent (NIDDM) an d insulin-dependent (IDDM) diabetic subjects, either normotensive or hypert ensive, were randomly assigned to receive PE (n = 20) or placebo (n = 20). A percutaneous renal biopsy was performed initially in all patients and rep eated in 29 patients after 3 years. The mean glomerular volume, glomerular basement membrane (GBM) thickness, interstitial fibrosis, sclerosed glomeru li, and volume fraction of capillary lumina were measured histomorphometric ally. Before treatment both groups had similar clinical characteristics, bl ood pressure, glycosylated hemoglobin (Hb), albumin excretion rate, glomeru lar filtration rate (GFR), serum creatinine, and renal structural damage. B lood pressure was well controlled in both groups. After 3 years' therapy, t here was no significant change in renal function and albuminuria in the PE or placebo groups. The increase in GBM thickness in nine paired biopsies wa s significantly less in PE-treated subjects (P=.0275). Interstitial fibrosi s tended to increase less in the PE group, although this did not reach stat istical significance. This study indicates that long-term therapy with PE m ay decrease or delay the progression of structural glomerular damage in mic roalbuminuric diabetic subjects. Copyright (C) 1998 by W.B. Saunders Compan y.