DIABETIC NEPHROPATHY IN CHILDREN AND ADOLESCENTS - A CRITICAL-REVIEW WITH PARTICULAR REFERENCE TO ANGIOTENSIN-CONVERTING ENZYME-INHIBITORS

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 al lowed early diagnosis and preventive interventions. Several studies ha ve demonstrated that treatment with angiotensin-converting enzyme (ACE ) inhibitors slows down the rate of decline of the glomerular filtrati on 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 appro priate class of antihypertensive drugs for treating type 1 diabetes pa tients because of their efficacy and safety. When microalbuminuria is detected and confirmed in a diabetic child or adolescent, and if it pe rsists despite 6-12 months of improved metabolic control, treatment wi th ACE inhibitors should be started, even if the child is normotensive . Careful follow-up of renal function is essential.