[Lack of effect of ACE inhibition on severe proteinuria in diabetic nephropathy--a 6-month-long study].

The effect of angiotensin converting enzyme inhibition with captopril therapy (3 x 12.5 mg/d) on heavy proteinuria and kidney function was investigated in 10 insulin-treated diabetic patients over a period of 6 months. Urinary protein excretion increased from 3706 mg/day (SD 1491) to 5405 (SD 2699) after 6 months of treatment (p = 0.05); serum creatinine rose from 248 mumol/l (SD 163) to 283 (SD 186) (p less than 0.01), whereas there was no significant difference in blood pressure before (150/80 mm Hg--SD 23/6) and after therapy (150/90 mm Hg--SD 23/10). HbA1c as a marker of metabolic long-term control decreased from 8.3% (SD 1.0) to 7.3% (SD 1.0) (p less than 0.05). No beneficial effects of low dose angiotensin converting enzyme inhibition on heavy proteinuria could be demonstrated in this group of patients with advanced diabetic nephropathy. In particular, progressive deterioration of kidney function was not influenced by the captopril treatment. In diabetic patients with incipient diabetic nephropathy presenting with microalbuminuria, further studies concerning a possible therapeutic effect are necessary.