Interventions based on microalbuminuria screening and low-protein diet in the treatment of kidney disease of diabetes mellitus.
Microalbuminuria in insulin-dependent diabetics appears to indicate early renal damage rather than susceptibility to it, yet a series of relatively small, short-term intervention studies in insulin-dependent diabetes mellitus patients have already demonstrated reduction in albumin excretion rates or arrest in the increase of fractional clearance of albumin. Treatments have ranged from the use of angiotensin-converting enzyme inhibitors aimed at lowering BP to the use of diets restricted to 0.5 to 0.6 g/kg protein and strict blood glucose control by intensified insulin treatment. Large, long-term intervention studies of cohorts of insulin-dependent and non-insulin-dependent diabetic patients with microalbuminuria are now needed to assess the effects of the different modalities of care on the development of persistent proteinuria, end-stage renal disease, and cardiovascular mortality as well as associated quantitative changes in the renal structure.
Viberti
G C
GC
Unit for Metabolic Medicine, UMDS, Guy's Hospital, London, England.
D000419:Albuminuria / Q000652:urine*; D000806:Angiotensin-Converting Enzyme Inhibitors / Q000627:therapeutic use; D003922:Diabetes Mellitus, Type 1 / Q000628:therapy* / Q000652:urine; D003928:Diabetic Nephropathies / Q000628:therapy* / Q000652:urine; D003927:Diet, Diabetic; D004044:Dietary Proteins / Q000008:administration & dosage; D006801:Humans; D007676:Kidney Failure, Chronic / Q000628:therapy
D000806:Angiotensin-Converting Enzyme Inhibitors; D004044:Dietary Proteins