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Does ACE inhibition slow progression of glomerulopathy in patients with Type 2 diabetes mellitus?

K E White1, N Pinel, D J Cordonnier

  • 1Department of Medicine, University of Newcastle, Newcastle upon Tyne, UK. K.E.White@ncl.ac.uk

Diabetic Medicine : a Journal of the British Diabetic Association
|November 13, 2001
PubMed
Abstract

Insights

Angiotensin-converting enzyme (ACE) inhibition may protect against interstitial changes in Type 2 diabetic nephropathy. However, larger studies are needed to confirm effects on glomerular structure.

Area of Science:

  • Nephrology
  • Diabetology
  • Pharmacology

Background:

  • Diabetic nephropathy is a major complication of Type 2 diabetes.
  • Angiotensin-converting enzyme (ACE) inhibitors are commonly used to manage hypertension and diabetic nephropathy.
  • The direct effect of ACE inhibition on glomerular structure in Type 2 diabetic nephropathy remains unclear.

Purpose of the Study:

  • To investigate the impact of ACE inhibition on glomerular and interstitial structural changes in patients with Type 2 diabetic nephropathy.

Main Methods:

  • A randomized, placebo-controlled trial involving 22 patients with Type 2 diabetic nephropathy.
  • Patients received either perindopril (an ACE inhibitor) or a placebo for 2 years.
  • Kidney biopsies were performed at baseline and after 2 years, with detailed electron microscopic examination of 11 patients.

Main Results:

  • While no significant changes in proteinuria or glomerular parameters were observed, the interstitial volume fraction increased significantly in the placebo group compared to the perindopril group.
  • This suggests that ACE inhibition may attenuate interstitial changes in Type 2 diabetic nephropathy.
  • No significant impact of ACE inhibition on glomerular structural parameters was detected in this small cohort.

Conclusions:

  • Interstitial changes in Type 2 diabetic nephropathy appear more sensitive to ACE inhibition than glomerulopathy.
  • Larger patient cohorts and longer treatment durations are required to ascertain the effects of ACE inhibition on glomerular structure in this population.

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