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Importance of reno-protection in adolescents with diabetes and microalbuminuria

M Loredana Marcovecchio & David B Dunger

Increases in urinary albumin excretion (microalbuminuria) can be detected in young people with Type 1 diabetes (T1D) during puberty, and they may indicate a risk for the development of overt diabetic nephropathy (DN) and cardiovascular disease. During adolescence, poor glycemic control, dyslipidemia, increases in blood pressure and inflammatory markers, female gender, and hormonal changes all contribute to the risk of microalbuminuria. Currently, interventions to reduce the long-term risk for DN in adolescents with T1D are mainly based on improving glycemic control, while there is no clear guidance on other potential cardio–renal protection strategies. The efficacy of angiotensin-converting enzyme inhibitors and statins is currently being investigated in adolescents with T1D at high risk of developing DN. In addition, there is growing interest in the development of new interventions targeting specific pathways implicated in DN.