Remission of nephrotic syndrome in type 1 diabetes: Long-term follow-up ofpatients in the captopril study

In 1994, we reported a 3.4 +/- 0.8 year follow-up of the eight patients who experienced remission of nephrotic syndrome during the Collaborative Study Group-sponsored, multicenter trial of captopril therapy in patients with t ype 1 diabetes with nephropathy (Captopril Study). Of the 409 patients rand omized to treatment on the Captopril Study, 108 had nephrotic syndrome (24- hour proteinuria greater than or equal to 3.5 g of protein) at baseline. Of these 108 patients, 8 experienced remission of nephrotic syndrome (protein uria less than or equal to 1.0 g/24 h of protein). Remission was significan tly associated with captopril therapy and control of systolic blood pressur e. The present study describes the status of these eight patients during a follow-up of 7.7 +/- 0.3 years. Since our previous report, one patient has been lost to follow-up and one patient progressed to end-stage renal diseas e (ESRD) 3.7 years after completion of the Captopril Study. The remaining s ix patients remain in remission of nephrotic syndrome (mean 24-hour protein uria, 1.03 +/- 0.3 g of protein) and have stable serum creatinine levels (m ean, 1.58 +/- 0.3 mg/dL) and body weights (mean, 69.8 +/- 5.3 kg). Of the s ix patients, one has discontinued angiotensin-converting enzyme inhibitor ( ACEI) therapy because of hypotension. Excluding the patient who progressed to ESRD, the current mean systolic brood pressure is 135 +/- 6 mm Hg and me an diastolic blood pressure is 78 +/- 4 mm Hg. We conclude that long-term r emission of nephrotic syndrome and preservation of renal function is achiev able in some patients with type 1 diabetes. Control of blood pressure and A CEI therapy appear to be important in achieving long-term remission. (C) 19 99 by the National Kidney Foundation, Inc.