الفهرس 
Type I Diabetes MellitusOnly 14 pages are availabe for public view
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Abstract
Diabetic nephropathy is the most common microvascular complication of type 1 diabetes, and it represents the leading cause of end-stage renal disease (ESRD) in developed countries (Gross et al., 2005).
The study aimed to assess the impact of treatment with angiotensin converting enzyme inhibitors (ACEI) on progression of diabetic nephropathy in patients with type 1 diabetes mellitus ..
The study was conducted in the Specialized Pediatric Diabetes clinic, Children’s Hospital, Ain Shams University in the period between October 1st 2011 till April 30th 2012.
It included 25 children and adolescents with type 1 DM, who were regularly followed up in the clinic , they were 10 males (40%) and 15 females (60%) , their ages ranged from 12 -31 years with mean age 21.56 ± 5.78 years and their disease duration ranged from 3-22 years with mean of 12.96 ± 5.02 years .
We followed up these patients at different stages :at diagnosis of diabetes mellitus(DM) , at diagnosis of diabetic nephropathy(DN), during ACEI therapy and at time of the study.
All patients were subjected to: full history taking, thorough clinical examination and laboratory investigation including: urinary albumin excretion (mg/dl) , HbAc1% and lipid profile at time of the study.
The results of the study showed:
- Percentage of female patients in the study was higher than males.
- - There was no significant difference in weight, height and BMI percentiles at different stages of study.
- -There was significant decrease in urinary microalbumin during treatment with ACEI therapy and at time of the study.
- -The percentage of patients with microalbuminuria and macroalbuminuria decreased from 100% at diagnosis of DN to 80% during ACEI therapy and then decrease to 40% at the time of study.
- Significant decrease in degree of urinary albumin excretion (UAE) (ug/ min) in different studied periods (P value < 0.001) at time of the study.
- -Twenty three patients (92%) were good compliant to treatment with ACEI and 2 patients (8%) were poor compliant to the therapy, and 14 (56%) of the patients with normal urinary microalbumin at time of the study were good compliant to the ACEI therapy.
- -There was significant relation between compliance of the patients to ACEI therapy and presence of other microvascular complications at time of the study.
- All patients with poor compliance to ACEI therapy had developed other microvascular complications .
- Nine patients (90%) of those patients who still microalbuminuric had poor glycemic control (HbA1c >7.5).
- Significant decrease in systolic BP percentiles at time of the study after treatment with ACEI therapy, although there was no significant correlation between microalbumin and systolic BP percentiles (r=0.233, P value >0.05) or diastolic BP percentiles (r= 0.124 , Pvalue >0.05) , may be due to effect of ACE inhibitors.
- There was significant increase in cholesterol and triglycerides at the time of the study compared to time of diagnosis of DM .
- 80% of patients who reverted to normoalbuminuric at time of the study had normal level of cholesterol (<200mg/dl), while 83% of these normoalbuminuric patients had normal level of triglycerides (<120mg/dl).
- The patients who reverted to normoalbuminuric had longer disease duration than who still microalbuminuric , however there was no significant difference between them as regards age ,duration of DN , systolic BP percentiles ,HbA1C % or dose of captopril (p value > 0.05) .
- There was no significant difference between normoalbuminuric patients and microalbuminuric at time of the study as regards age ,duration of DM, duration of the DN ,systolic and diastolic Bp, cholesterol , triglycerides and HbA1c and dose of captopril (p>0.05).
Also the results showed no correlation between microalbumin versus:
- Age, weight, height, BMI, Duration of DM , duration of DN, Systolic and diastolic BP percentiles, HbA1c% , dose of captopril and Lipid profile (cholesterol and triglycerides) (p-value >0,05).
This study has proved that treatment with ACE inhibitors in type 1 diabetic patients with diabetic nephropathy have been shown to significantly reduce the risk for progression of nephropathy and increase the rate of its regression.