From Montgomery, Alabama, USA:
Do you believe that all Type 1 diabetics should be treated with prophylactic doses of ace inhibitors even before any evidence of protein in the urine is found? I am the parent of a 5 year old son who was diagnosed at age three. Of course, I am concerned about his long term health. Among my son's health care team there are varying opinions. My son's endocrinologist doesn't think it is needed unless there is some elevated protein levels in a specimen.
I agree with your son's endocrinologist. ACE inhibitors may be of benefit in delaying future renal impairment in type 1 diabetic patients only when microalbumin are confirmed to be present in more than one 24 hour urine sample. This condition is very rare in children and prepubertal boys. There is no indication that these medications have a prophylactic role.
Additional comments from Dr. William Quick:ACE inhibitors are useful in the treatment of hypertension, some heart disorders, and diabetic kidney disease. They do have side effects, however, and there are no studies that I am aware of that show that they can protect against future diabetic kidney disease in somebody with no kidney damage.
On the other hand, as discussed by Dr. Songini, if there is consistent microalbuminuria (a laboratory finding that implies diabetic nephropathy may be developing), ACE inhibitors are thought to be able to help prevent or delay the onset of full-fledged kidney disease.
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