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protein excretion considerably. Individual differences in the renin-angioshould be reduced as far as possible [73]. The antiprotein- tensin system can influence this variation. Two studies uric effect of ACE inhibitors is well documented, but suggest that patients with type 1 diabetes who have the ACE inhibitors reduce angiotensin II formation and in- II genotype of the ACE gene are particularly sensitive to duce bradykinin accumulation. To dissect these effects, we commonly advocated renoprotective treatment [76, 77]. performed a double-blind, randomized, cross-over study Furthermore, the polymorphism of the ACE gene precomparing an angiotensin II type 1 receptor antagonist, dicts therapeutic efficacy of ACE inhibition against prolosartan, with enalapril in patients with type 1 diabetes gression of nephropathy in patients with type 1 (and type and nephropathy [74]. The study showed that losartan’s 2) diabetes (abstract; Tomonaga et al, J Am Soc Nephrol ability to reduce albuminuria and blood pressure is simi- 8:120A, 1997) [40]. We recently demonstrated that the lar to the effect of ACE inhibitors. These results indicate individual antiproteinuric response to ACE inhibition Nephrology Forum: Diabetic nephropathy 2047 positively correlated with the response to angiotensin sive benefit with time has been demonstrated on GFR II type 1 receptor blockade in diabetic as well as in in non-diabetic renal diseases [86]. Remission of proteinnondiabetic patients [78]. Thus, patients responding fa- uria for at least one year (proteinuria 1 g/24 h) has been vorably to one class of antiproteinuric drugs also respond described in patients with type 1 diabetes participating in favorably to other classes of available drugs. This finding the captopril collaborative study [87]. Eight of 108 pasupports a main role for individual patient factors in tients experienced remission during long-term follow-up responsiveness or resistance to antiproteinuric interven- [87]. We recently confirmed and extended these findings tion. in a long-term prospective observational study of 321 From a clinical point of view, the ability to predict the patients with type 1 diabetes and nephropathy [abstract; long-term effect of a recently initiated treatment modality, Hovind et al, Diabetologia 43(Suppl 1):A36, 2000]. The for example, antihypertensive treatment, on renal func- cumulative incidence of nephrotic-range albuminuria tion would be of great value. In prospective studies deal- was 39%.
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