The efficacy of ACE-inhibitors in preventing progressive kidney
impairment in patients with GSDI is still debatable. We
have previously demonstrated, in a retrospective multicenter
study, that ACE-inhibitors are effective in reducing glomerular
hyperfiltration but not in reverting microalbuminuria
and proteinuria in patients with GSDI. We also showed
that the ACE-inhibitors significantly delayed the progression
of renal damage only if the therapy was started when glomerular
hyperfiltration was detected.3 In the current study, a
retrospective-prospective multicenter study covering a
20-year follow-up, we have confirmed the efficacy of ACEinhibitors
on glomerular hyperfiltration. Thus, our data suggest
the correct timing for starting the therapy. In particular,
the definitive demonstration of the efficacy of ACEinhibitors
exclusively in normoalbuminuric patients suggests
that at the first detection of glomerular hyperfiltration, ACEinhibitor
treatment should be started to improve and delay
the progression of renal damage