title: High rate of regression from micro-macroalbuminuria to normoalbuminuria in children and adolescents with type 1 diabetes treated or not with enalapril: the influence of HDL cholesterol.
abstract: OBJECTIVE
  To evaluate the frequency of normalization, the persistence of remission, and the impact on normalization of glycemic control and lipid profile, we analyzed data from a retrospective observational cohort study of type 1 diabetic children and adolescents with abnormal urinary albumin excretion (UAE).
  
  
  METHODS
  All diabetic children and adolescents (n = 41) who had persistent abnormal UAE in the period of 1984 to 2008 and followed up until 2009 (follow-up duration = 13.1 ± 6.2 years) were included in the study. Nine patients progressed to macroalbuminuria; 24 patients were administered ACE inhibitor treatment.
  
  
  RESULTS
  The cumulative prevalence of abnormal UAE was 9%. During follow-up, 14 of 17 untreated and 19 of 24 treated patients reverted to normoalbuminuria. In the remission group compared with the nonremission group, A1C levels during follow-up decreased (7.5 ± 1.0 vs. 9.4 ± 1.2%, P < 0.0001) and serum HDL cholesterol increased (52.7 ± 11.3 vs. 42.7 ± 8.6 mg/dL, P < 0.05). The micro-macroalbuminuric patients had lower HDL cholesterol (51.0 ± 11.4 vs. 62.4 ± 13.6 mg/dL, P < 0.0001) than 134 normoalbuminuric diabetic patients.
  
  
  CONCLUSIONS
  Microalbuminuria and macroalbuminuria were not permanent in most of our diabetic children and adolescents. If abnormal UAE values are high and persist for >1 year, only long-lasting treatment with ACE inhibitors seems able to induce persistent remission, especially when associated with good metabolic control and high HDL cholesterol levels.
authors.affiliation: Department of Pediatrics, S Orsola-Malpighi Hospital, University of Bologna, Bologna, Italy. silvana.salardi@unibo.it
authors.forename: Silvana
authors.initials: S
authors.lastname: Salardi
authors.forename: Claudia
authors.initials: C
authors.lastname: Balsamo
authors.forename: Stefano
authors.initials: S
authors.lastname: Zucchini
authors.forename: Giulio
authors.initials: G
authors.lastname: Maltoni
authors.forename: Mirella
authors.initials: M
authors.lastname: Scipione
authors.forename: Alessandra
authors.initials: A
authors.lastname: Rollo
authors.forename: Stefano
authors.initials: S
authors.lastname: Gualandi
authors.forename: Alessandro
authors.initials: A
authors.lastname: Cicognani
mesh_terms: D000293:Adolescent; D000419:Albuminuria / Q000188:drug therapy* / Q000453:epidemiology / Q000378:metabolism; D000806:Angiotensin-Converting Enzyme Inhibitors / Q000008:administration & dosage; D002648:Child; D008076:Cholesterol, HDL / Q000378:metabolism*; D003922:Diabetes Mellitus, Type 1 / Q000188:drug therapy* / Q000453:epidemiology / Q000378:metabolism; D003928:Diabetic Nephropathies / Q000188:drug therapy* / Q000453:epidemiology / Q000378:metabolism; D018450:Disease Progression; D004656:Enalapril / Q000008:administration & dosage*; D005500:Follow-Up Studies; D006801:Humans; D006943:Hyperglycemia / Q000188:drug therapy / Q000453:epidemiology / Q000378:metabolism; D008137:Longitudinal Studies; D015995:Prevalence; D012074:Remission Induction; D012189:Retrospective Studies
chemical_list: D000806:Angiotensin-Converting Enzyme Inhibitors; D008076:Cholesterol, HDL; D004656:Enalapril