H. Yuksel et al., EFFECT OF ENALAPRIL ON PROTEINURIA, PHOSPHATURIA, AND CALCIURIA IN INSULIN-DEPENDENT DIABETES, Pediatric nephrology, 12(8), 1998, pp. 648-650
Elevated urinary calcium and phosphate excretion have been observed in
children with insulin-dependent diabetes mellitus (IDDM). This may be
related to a defect in tubular reabsorption. It is well known that co
nverting enzyme inhibition decreases microalbuminuria and may prevent
or retard diabetic nephropathy. We investigated whether enalapril also
improves the defect in calcium and phosphate reabsorption, We studied
16 children and young adults (age 12-21 years) with IDDM and persiste
nt microalbuminuria before and during 12 weeks of enalapril treatment.
Before treatment microalbuminuria, urinary calcium excretion, and fra
ctional tubular phosphorus reabsorption (TPR) were 153+/-53 mu g/min,
5.5+/-0.9 mg/kg per day, and 71.4+/-3.6%, respectively. At the end of
the 12th week, microalbuminuria had decreased to 20.3+/-7.9 mu g/min a
nd calcium excretion to 3.3+/-0.4 mg/kg per day (P<0.01), while the TP
R increased to 80.1+/-3.8% (NS). The renal threshold phosphate concent
ration increased from 1.8+/-0.15 to 2.92+/-0.23 mg/dl (P<0.01). The fa
sting serum,glucose and hemoglobin Al, levels did not change significa
ntly during the study. Systolic and diastolic blood pressures were 120
.4+/-2.2/79.3+/-1.4 mm HE and 110.5+1.8/71.3+/-0.9 mm Hg before and af
ter 12 weeks, respectively. We conclude that enalapril treatment impro
ves not only microalbuminuria but also abnormal calcium and phosphate
excretion in microalbuminuric children with IDDM.