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American Journal of Kidney Diseases

Remission of nephrotic syndrome in type 1 diabetes: Long-term follow-up of patients in the Captopril Study

  • William A. Wilmer
    Affiliations
    Ohio State University, Columbus; Northeast Ohio University College of Medicine, Canton, OH; Rush Medical Center, Chicago, IL; New England Medical Center, Boston, MA; Vanderbilt University, Nashville, TN; Brookdale Medical Center, Brooklyn, NY; Medical College of Wisconsin, Milwaukee, WI; George Washington University, Washington, DC; and the University of Toronto, Toronto, Canada. For the Collaborative Group, Chicago, IL.
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  • Lee A. Hebert
    Affiliations
    Ohio State University, Columbus; Northeast Ohio University College of Medicine, Canton, OH; Rush Medical Center, Chicago, IL; New England Medical Center, Boston, MA; Vanderbilt University, Nashville, TN; Brookdale Medical Center, Brooklyn, NY; Medical College of Wisconsin, Milwaukee, WI; George Washington University, Washington, DC; and the University of Toronto, Toronto, Canada. For the Collaborative Group, Chicago, IL.
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  • Edmund J. Lewis
    Affiliations
    Ohio State University, Columbus; Northeast Ohio University College of Medicine, Canton, OH; Rush Medical Center, Chicago, IL; New England Medical Center, Boston, MA; Vanderbilt University, Nashville, TN; Brookdale Medical Center, Brooklyn, NY; Medical College of Wisconsin, Milwaukee, WI; George Washington University, Washington, DC; and the University of Toronto, Toronto, Canada. For the Collaborative Group, Chicago, IL.
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  • Richard D. Rohde
    Affiliations
    Ohio State University, Columbus; Northeast Ohio University College of Medicine, Canton, OH; Rush Medical Center, Chicago, IL; New England Medical Center, Boston, MA; Vanderbilt University, Nashville, TN; Brookdale Medical Center, Brooklyn, NY; Medical College of Wisconsin, Milwaukee, WI; George Washington University, Washington, DC; and the University of Toronto, Toronto, Canada. For the Collaborative Group, Chicago, IL.
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  • Frederick Whittier
    Affiliations
    Ohio State University, Columbus; Northeast Ohio University College of Medicine, Canton, OH; Rush Medical Center, Chicago, IL; New England Medical Center, Boston, MA; Vanderbilt University, Nashville, TN; Brookdale Medical Center, Brooklyn, NY; Medical College of Wisconsin, Milwaukee, WI; George Washington University, Washington, DC; and the University of Toronto, Toronto, Canada. For the Collaborative Group, Chicago, IL.
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  • Daniel Cattran
    Affiliations
    Ohio State University, Columbus; Northeast Ohio University College of Medicine, Canton, OH; Rush Medical Center, Chicago, IL; New England Medical Center, Boston, MA; Vanderbilt University, Nashville, TN; Brookdale Medical Center, Brooklyn, NY; Medical College of Wisconsin, Milwaukee, WI; George Washington University, Washington, DC; and the University of Toronto, Toronto, Canada. For the Collaborative Group, Chicago, IL.
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  • Andrew S. Levey
    Affiliations
    Ohio State University, Columbus; Northeast Ohio University College of Medicine, Canton, OH; Rush Medical Center, Chicago, IL; New England Medical Center, Boston, MA; Vanderbilt University, Nashville, TN; Brookdale Medical Center, Brooklyn, NY; Medical College of Wisconsin, Milwaukee, WI; George Washington University, Washington, DC; and the University of Toronto, Toronto, Canada. For the Collaborative Group, Chicago, IL.
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  • Julia Breyer Lewis
    Affiliations
    Ohio State University, Columbus; Northeast Ohio University College of Medicine, Canton, OH; Rush Medical Center, Chicago, IL; New England Medical Center, Boston, MA; Vanderbilt University, Nashville, TN; Brookdale Medical Center, Brooklyn, NY; Medical College of Wisconsin, Milwaukee, WI; George Washington University, Washington, DC; and the University of Toronto, Toronto, Canada. For the Collaborative Group, Chicago, IL.
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  • Samuel Spitalewitz
    Affiliations
    Ohio State University, Columbus; Northeast Ohio University College of Medicine, Canton, OH; Rush Medical Center, Chicago, IL; New England Medical Center, Boston, MA; Vanderbilt University, Nashville, TN; Brookdale Medical Center, Brooklyn, NY; Medical College of Wisconsin, Milwaukee, WI; George Washington University, Washington, DC; and the University of Toronto, Toronto, Canada. For the Collaborative Group, Chicago, IL.
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  • Samuel Blumenthal
    Affiliations
    Ohio State University, Columbus; Northeast Ohio University College of Medicine, Canton, OH; Rush Medical Center, Chicago, IL; New England Medical Center, Boston, MA; Vanderbilt University, Nashville, TN; Brookdale Medical Center, Brooklyn, NY; Medical College of Wisconsin, Milwaukee, WI; George Washington University, Washington, DC; and the University of Toronto, Toronto, Canada. For the Collaborative Group, Chicago, IL.
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  • Raymond P. Bain
    Affiliations
    Ohio State University, Columbus; Northeast Ohio University College of Medicine, Canton, OH; Rush Medical Center, Chicago, IL; New England Medical Center, Boston, MA; Vanderbilt University, Nashville, TN; Brookdale Medical Center, Brooklyn, NY; Medical College of Wisconsin, Milwaukee, WI; George Washington University, Washington, DC; and the University of Toronto, Toronto, Canada. For the Collaborative Group, Chicago, IL.
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      Abstract

      In 1994, we reported a 3.4 ± 0.8 year follow-up of the eight patients who experienced remission of nephrotic syndrome during the Collaborative Study Group–sponsored, multicenter trial of captopril therapy in patients with type 1 diabetes with nephropathy (Captopril Study). Of the 409 patients randomized to treatment on the Captopril Study, 108 had nephrotic syndrome (24-hour proteinuria ≥ 3.5 g of protein) at baseline. Of these 108 patients, 8 experienced remission of nephrotic syndrome (proteinuria ≤ 1.0 g/24 h of protein). Remission was significantly associated with captopril therapy and control of systolic blood pressure. The present study describes the status of these eight patients during a follow-up of 7.7 ± 0.3 years. Since our previous report, one patient has been lost to follow-up and one patient progressed to end-stage renal disease (ESRD) 3.7 years after completion of the Captopril Study. The remaining six patients remain in remission of nephrotic syndrome (mean 24-hour proteinuria, 1.03 ± 0.3 g of protein) and have stable serum creatinine levels (mean, 1.58 ± 0.3 mg/dL) and body weights (mean, 69.8 ± 5.3 kg). Of the six patients, one has discontinued angiotensin-converting enzyme inhibitor (ACEi) therapy because of hypotension. Excluding the patient who progressed to ESRD, the current mean systolic blood pressure is 135 ± 6 mm Hg and mean diastolic blood pressure is 78 ± 4 mm Hg. We conclude that long-term remission of nephrotic syndrome and preservation of renal function is achievable in some patients with type 1 diabetes. Control of blood pressure and ACEi therapy appear to be important in achieving long-term remission.

      Keywords

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