Intensive diabetes management decreases Na–Li countertransport in young subjects with Type 1 diabetes and enlarged kidneys

• Published in: Journal of diabetes and its complications 2000-11, Vol.14 (6), p.333-339
• Main Authors: Lawson, Margaret L, Sochett, Etienne B, Frank, Marcia R, Fry, Marilyn K, Stephens, Derek, Chait, Peter, Daneman, Denis
• Format: Article
• Language: English
• Subjects: ACE inhibition; Adolescent; Albuminuria - prevention & control; Angiotensin-Converting Enzyme Inhibitors - therapeutic use; Antihypertensive agents; Antiporters - metabolism; Biological and medical sciences; Cardiovascular system; Child; Cross-Over Studies; Diabetes Mellitus, Type 1 - drug therapy; Diabetes Mellitus, Type 1 - metabolism; Diabetes Mellitus, Type 1 - pathology; Diabetic Nephropathies - prevention & control; Enalapril - therapeutic use; Female; Glycated Hemoglobin A - analysis; Hormones. Endocrine system; Humans; Hypertrophy; Intensive management; Kidney - pathology; Kidney size; Lithium - metabolism; Male; Medical sciences; Microalbuminuria; Na–Li countertransport; Pharmacology. Drug treatments; Reference Values; Renin - blood; Sodium - metabolism
• ISSN: 1056-8727; 1873-460X
• DOI: 10.1016/S1056-8727(00)00088-X

In type 1 diabetes, increases in sodium–lithium countertransport (Na–Li CT), kidney volume (KV), and albumin excretion rate (AER) may precede the development of persistent microalbuminuria. Limited data exist on reversibility of these factors early in the evolution of diabetic nephropathy. A crossover design was used to study the separate effects of enalapril and intensive diabetes management (IDM) on Na–Li CT, KV and AER in 17 children and adolescents with type 1 diabetes (5–10 years duration) with large kidneys (>275 ml/1.73 m 2) and predominantly normoalbuminuria. Subjects were randomized to receive 3 months of either enalapril (0.25 mg/kg/day) or IDM, a 3-month washout, followed by the alternate treatment for 3 months. During IDM, HbA1c decreased 2.5% (pre 9.5±0.3% (mean±SE), post 7.0±0.1%, p