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KEY POINTS: NEPHROPATHY

Nephropathy has traditionally occurred in 30-40% of people with type 1 diabetes.
Mortality from complications of nephropathy in type 1 diabetes was 80% in 1971, 40% in 1984, and 20% in 1996. With modern intensive management of glucose, blood pressure, albuminuria, and the synthesis and/or action of angiotensin II, the incidence of nephropathy and its cardiovascular complications will continue to decrease.
Intensive glucose management, with a HbAlc goal of < 7%, will decrease occurrence of microalbuminuria and subsequent diabetic nephropathy.
If microalbuminuria (> 30 mg/24 hr) is present, therapy with angiotensin-converting enzyme inhibitors leads to regression of microalbuminuria and delays the progression to clinical albuminuria (> 300 mg/24 hr) and/or end-stage renal failure. These effects are seen in normotensive as well as hypertensive type 1 diabetic patients vvith microalbuminuria.
ACE inhibitor therapy in type 1 diabetic patients with clinical albuminuria and an elevated serum creatinine leads to a 48-50% reduction in the risk of doubling of serum creatinine or progression to end-stage renal disease
*66\357\8*

KEY POINTS: NEPHROPATHYNephropathy has traditionally occurred in 30-40% of people with type 1 diabetes.Mortality from complications of nephropathy in type 1 diabetes was 80% in 1971, 40% in 1984, and 20% in 1996. With modern intensive management of glucose, blood pressure, albuminuria, and the synthesis and/or action of angiotensin II, the incidence of nephropathy and its cardiovascular complications will continue to decrease.  Intensive glucose management, with a HbAlc goal of < 7%, will decrease occurrence of microalbuminuria and subsequent diabetic nephropathy.If microalbuminuria (> 30 mg/24 hr) is present, therapy with angiotensin-converting enzyme inhibitors leads to regression of microalbuminuria and delays the progression to clinical albuminuria (> 300 mg/24 hr) and/or end-stage renal failure. These effects are seen in normotensive as well as hypertensive type 1 diabetic patients vvith microalbuminuria.ACE inhibitor therapy in type 1 diabetic patients with clinical albuminuria and an elevated serum creatinine leads to a 48-50% reduction in the risk of doubling of serum creatinine or progression to end-stage renal disease*66\357\8*

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