Management of early diabetic nephropathy in adolescents with type 1 diabetes mellitus

Microalbuminuria (MA) remains the best predictive marker for the development of diabetic nephropathy and it is independently associated with risk for cardiovascular disease. The development of MA during adolescence is independently related to HbA_1c, gender, duration of disease and pubertal onset. Even where MA regresses towards the end of puberty, it probably represents morphological changes in the kidney. Presently there is no consensus as to how MA should be managed during adolescence and we propose a trial of early intervention based on risk assessed by albumin excretion and HbA_1c. Copyright © 2005 John Wiley & Sons, Ltd.