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A 14-year-old girl with type 1 diabetes mellitus (DM) attends clinic for her annual review appointment. An albumin creatinine ratio (ACR) on spot urine is 7.3 mg/mmol. Her blood pressure is 125/67 and HbA1c is 9.2%. Subsequently, three consecutive early morning urine samples have ACR of 6.8, 5.7 and 7.3 mg/mmol, respectively, and remain elevated when repeated 3 and 6 months later. You are aware that in adult women with diabetes persistent microalbuminuria (MA) is defined as an ACR greater than 3.5 mg/mmol on two out of three successive occasions, and that in such adults, treatment with angiotensin converting enzyme inhibitors (ACEi) confers renoprotection. You wonder whether your patient should be treated.
STRUCTURED CLINICAL QUESTION
In children with type 1 diabetes with persistent microalbuminuria [patient], does the use of ACEi [intervention] reduce urinary albumin excretion rate [outcome]?
SEARCH STRATEGY AND OUTCOME
Secondary sources: Cochrane database and BestBETs were searched using the term “Angiotensin” in the “Title, Abstract or Keywords” field: no review of ACEi use in children was found.
Primary sources: Medline via PubMed. Search terms: (“Angiotensin-Converting Enzyme Inhibitors”[MeSH] OR “Angiotensin-Converting Enzyme Inhibitors”[Pharmacological Action]) AND “Diabetes Mellitus”[MeSH], limited to: All Child 0–18 years; 103 articles were found. To locate articles that had been published but were still waiting to be indexed, another search was carried out with the terms: ((angiotensin converting enzyme inhibitors) OR (ace inhibitors) OR …