Journal Article

Renal and Retinal Effects of Enalapril and Losartan in Type 1 Diabetes

Gubler, Marie Claire, Gardiner, Robert, Drummond, Keith, Mauer, Michael, Suissa, Samy, Strand, Trudy, Sinaiko, Alan, Klein, Ronald, Zinman, Bernard, Donnelly, Sandra, Goodyer, Paul

2009

Overview

This study aimed to determine whether early administration of drugs that block the renin–angiotensin system slows the progression of change in glomerular mesangial fractional volume and retinopathy progression of two steps or more, according to the retinopathy severity scale. Early blockade of the renin–angiotensin system did not modify nephropathy progression in patients with type 1 diabetes but had important effects in slowing retinopathy. Early blockade of the renin–angiotensin system did not modify nephropathy progression in patients with type 1 diabetes but had important effects in slowing retinopathy. Diabetic nephropathy, responsible for more than 45% of cases of end-stage renal disease in the United States, 1 may be structurally advanced once albuminuria becomes detectable. 2 , 3 Blockers of the renin–angiotensin system are more effective than other antihypertensive agents in slowing nephropathy progression in patients who have proteinuria, diabetes mellitus, and a reduced glomerular filtration rate (GFR), 4 – 6 and such blockers can also decrease proteinuria in patients with diabetes. 7 Although the reduction of proteinuria in patients with diabetes has been associated with a reduction in the rate of decline in GFR in small studies, 8 this association has not been systematically tested; . . .

• Publisher: Massachusetts Medical Society
• Subject: Adult / Albuminuria / Angiotensin II Type 1 Receptor Blockers - adverse effects / Angiotensin II Type 1 Receptor Blockers - pharmacology / Angiotensin II Type 1 Receptor Blockers - therapeutic use / Angiotensin-Converting Enzyme Inhibitors - adverse effects / Angiotensin-Converting Enzyme Inhibitors - pharmacology / Angiotensin-Converting Enzyme Inhibitors - therapeutic use / Biological and medical sciences / Diabetes / Diabetes Mellitus, Type 1 - drug therapy / Diabetes Mellitus, Type 1 - pathology / Diabetes Mellitus, Type 1 - physiopathology / Diabetes. Impaired glucose tolerance / Diabetic Nephropathies - prevention & control / Diabetic retinopathy / Diabetic Retinopathy - prevention & control / Disease Progression / Double-Blind Method / Drug dosages / Enalapril - adverse effects / Enalapril - pharmacology / Enalapril - therapeutic use / Endocrine pancreas. Apud cells (diseases) / Endocrinopathies / Etiopathogenesis. Screening. Investigations. Target tissue resistance / Female / Follow-Up Studies / General aspects / Glomerular Filtration Rate - drug effects / Humans / Kaplan-Meier Estimate / Kidney Glomerulus - drug effects / Kidney Glomerulus - pathology / Kidneys / Logistic Models / Losartan - adverse effects / Losartan - pharmacology / Losartan - therapeutic use / Male / Medical sciences / Mesangial Cells - drug effects / Mesangial Cells - pathology / Renin-Angiotensin System - drug effects / Retina - drug effects / Retina - pathology