Prevention and treatment of diabetic nephropathy: role of angiotensin-converting enzyme inhibitors.
OBJECTIVE
To discuss the role of angiotensin-converting enzyme inhibitors in the management of diabetes-related renal disease.


METHODS
We review the published data from animal studies and clinical trials and outline the adverse effects that may limit the use of these drugs.


RESULTS
Diabetic nephropathy is the most common cause of end-stage renal disease and dialysis in the United States. With improving measures to optimize blood glucose control and blood pressure, the progression from mild proteinuria to overt renal insufficiency can now be retarded or even arrested. Studies of therapeutic interventions have shown that angiotensin-converting enzyme inhibitors have a superior beneficial effect on nephropathy. Few adverse effects are associated with use of these drugs: a nonproductive cough is the most frequent side effect, and angioedema and agranulocytosis are the most serious (albeit rarely reported) effects.


CONCLUSIONS
Angiotensin-converting enzyme inhibitors should be considered as first-line therapy for patients with diabetes who have microalbuminuria or macroalbuminuria.
Karlsson
F O
FO
Department of Medicine, Baylor College of Medicine, and The Methodist Hospital, Houston, Texas 77030, USA.
Garber
A J
AJ