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Evaluation of role of Low Molecular Weight Heparin and Vitamin E on renal functions in patients with diabetic nephropathy

Yıl 2011, Cilt: 38 Sayı: 2, 129 - 133, 01.06.2011
https://doi.org/10.5798/diclemedj.0921.2011.02.0001

Öz

Objectives: Diabetes has been reported to increase the risk of end stage renal disease. To prevent the progres­sion of diabetic nephropathy (DN) search for newer ap­proaches is warranted as diabetic patients despite good metabolic control show progressive renal damage. The aim of this study was to investigate the role of low molecu­lar heparin (LWMH) and vitamin E in patients with diabetic nephropathy. Materials and methods: Twenty five clinically proved adult cases of DN with adequate glycemic and blood pressure control achieved with insulin or oral hypoglyce­mics and anti hypertensive agents (excluding ACE inhibi­tors and ARBs) were included. At the start of the study, patients were put on LWMH (3200 IU S/C once daily) for one month and thereafter a washout period of one month was given, following which patients received anti-oxidant vitamin-E (200mg, once daily) for three months. Results: Patients at the baseline have microalbuminuria levels ranging for 41.0 to 290.0 mg/ 24hr. One month of LMWH reduced it from 133.0±74.4 to 93.3±62.1 mg/24hr (p0.05). The microalbuminuria levels did not revert back to the baseline till the end of the study (5 months). Conclusion: Our results indicated that, though not a part of standard regime, LMWH treatment followed by vitamin E supplementation needs to be considered in the incipient stage of DN.

Kaynakça

  • Mogensen CE Microalbuminuria as a predictor of clinical diabetic nephropathy. Kidney Int 1987; 31(2): 673-89.
  • Gross JL, Azevedo MJ, Silveiro SP, Canani LH, Caramori ML, Zelrnanovitz T. Diabetic Nephropathy: Diagnosis, prevention, and treatment. Diabetes Care 2005; 28(1): 164- 76.
  • Deckert T, Feldt-Rasmussen B, Borch-Johnsen K, Jensen T, Kofoed-Enevoldsen A. Albuminuria reflects widespread vascular damage. The Steno hypothesis. Diabetologia 1988; 32(4): 219-26.
  • Gambaro G, Skrha J, Ceriello A. Glycosaminoglycan therapy for long-term diabetic complications? Diabetologia 1998; 41(8): 975-9.
  • Cohen MP, Surma ML. 35S sulfate incorporation into glom- erular basement membrane glycosaminoglycans is de- creased in experimental diabetes. J Lab Clin Med 1981; 98(5): 715 -22.
  • Gambaro G, Kinalska I, Oksa A, et al . Oral Sulodexide reduces albuminuria in microalbuminuric and macroalbu- minuric Type 1 and Type 2 diabetic patients: The Di.N.A.S. Randomized Trial. J Am Soc Nephrol 2002; 13(6): 1615- 25.
  • Gambaro G, Cavazzana AO, Luzi P, et al. Glycosaminogly- cans prevent morphological renal alterations and albuminu- ria in diabetic rats. Kidney Int 1992; 42(2): 285-91.
  • Tamsma JT, van der Woude FJ, Lemkes HHPJ. Effect of sul- fated glycosaminoglycans on albuminuria in patients with overt diabetic (type-1) nephropathy. Nephrol Dial Trans- plant 1996; 11(1): 182-5.
  • Van der Pijl JW, van der Woude FJ, et al. Danaparoid so- dium lowers proteinuria in diabetic nephropathy. J Am Soc Nephrol 1997; 8(3): 456-62.
  • Solini A, Carrara A, Barzon I, Crepaldi G. Therapy with glycosaminoglycans lowers albumin excretion rate in nonıinsulin dependent diabetic patients with microalbu- minuria. Diab Nutr Metab 1994; 7(3): 304-7.
  • Skrha J, Perusicova J, Pontuch P, Oksa A. Glycosaminogly- can sulodexide decreases albuminuria in diabetic patients. Diab Res Clin Pract 1997; 38(1): 25-31.
  • Poplawska A, Szelachowska M, Topolska J, Wysocka- Solowie B, Kinalska I. Effect of glycosaminoglycans on urinary albumin excretion in insulin-dependent diabetic patients with micro- or macroalbuminuria. Diab Res Clin Pract 1997; 38(2): 109-14.
  • Dedov I, Shestakova M, Vorontzov A, Palazzini E. A ran- domized, controlled study of sulodexide therapy for the treatment of diabetic nephropathy. Nephrol Dial Transplant 1997; 12(11): 2295-300.
  • Szelanowska M, Poplawska A, Jopdska J, Kinalska I, Grimaldi M. A pilot study of the effect of the glycosamino- glycan sulodexide on microalbuminuria in type 1 diabetic patients. Curr Med Res Opin 1997; 13(9): 539-45.
  • Ha H, Lee HB. Oxidative stress in diabetic nephropathy basic and clinical information. Curr Diab Rep 2001; 1(3): 282-7.
  • Karpen CW, Cataland S, O Doriso TM,Panganamala RV. Production of 12-hydroxyeicosatetraenoic acid and vita- min E status in platelets from type human diabetic subjects. Diabetes1985;34(6):526-3.
  • Kowluru RA, Abbas SN, Odenbach S. Reversal of hyperg- lycemia and diabetic nephropathy: effect of reinstitution of good metabolic control on oxidative stress in the kidney of diabetic rats. J Diabetes Complications 2004; 18(5):282-8.
  • Nielsen S, Schmitz A, Bacher T, Rehling M, Ingerslev J, Mogensen CE. Transcapillary escape rate and albuminuria in type II diabetes: Effects of short term treatment with I ow-molecular weight heparin. Diabetologia 1999; 42(1): 60 -7.
  • Van der Woude FJ,Van Det NF.Heparan sulphate proteo- glycans and diabetic nephropathy. Exp Nephro11997;5 (3):180-8.
  • Castellot JJ, Hoover RL, Harper PA, Karnovsky MJ. Hepa- rin and glomerular epithelial cell secreted heparin-like spe- cies inhibit mesangial cell proliferation. Am J Pathol 1985; 120(3): 427-35.
  • Hirnerova E, Krahulec B, Strbova L, et al.effect of vitamin E supplementation on microalbuminuria,lipid peroxidation and blood prostaglandins in diabetic patients. Bratis Lek Listy 2004;105(12):408-13.
  • Yokoyama M, Torita M, Yoshizawa M, Usuda R.indication of vitamin E on microalbuminuria in patients with incipient diabetic nephropathy. Diabetes Metab 2001;27(5):611-2.
  • Nakamura T, Ushiyama C, Suzuki S. Effect of taurine and vit E on mircoalbuminuria, plasma metalloproteinase and serum type IV collagen concentration in patients with dia- betic nephropathy. Nephron 1999;83(4):361-2.
  • Suzuki D, Miyata T. Carbonyl stress in pathogenesis of dia- betic nephropathy. Int Med 1999;38(4):309-14.

Evaluation of role of Low Molecular Weight Heparin and Vitamin E on renal functions in patients with diabetic nephropathy

Yıl 2011, Cilt: 38 Sayı: 2, 129 - 133, 01.06.2011
https://doi.org/10.5798/diclemedj.0921.2011.02.0001

Öz

Amaç: Diyabetin son dönem böbrek yetmezliği riskini artırdığı bildirilmiştir. Diyabetik nefropatinin ilerlemesini önlemede yeni yaklaşımlar gereklidir, çünkü iyi metabolik kontrole rağmen diyabetik hastalar ilerleyici böbrek hasa­rı gösterir. Bu çalışmanın amacı düşük molekül ağırlıklı heparin ve vitamin E\'nin diyabetik nefropatili hastalardaki rolünü araştırmaktır. Gereç ve yöntem: Klinik olarak kanıtlanmış, yeterli gli­semik kontolu ve kan basıncı kontrolu insulin, oral hipog­lisemikler ve kan basıncı düşürücüler (ACE inhibitörü ve ARB\'ler hariç) ile sağlanmış, diyabetik nefropatisi olan 25 erişkin hasta çalışmaya dahil edildi. Çalışmanın başlangı­cında hastalara DMAH (3200 Ünite, subkutan günde bir kez) bir ay verildi ve takiben bir ay beklenip daha sonra üç ay süreyle E vitamini (Günde bir kez 200 mg) verildi. Bulgular: Hastaların bazal mikroalbuminüri değerleri, 41.0 ile 290.0 mg/24 st arasında değişiyordu. Bir aylık DMAH bu değeri 133.0 ± 74.4 mg/24 st\'den 93.3 ± 62.1 mg/24 st\'e düşürdü (p 0.05). Mikro­albuminüri değerleri çalışma süresi olan 5 ayın sonunda başlangıçtaki bazal değerlere dönmemiş olduğu görüldü. Sonuç: Çalışmamızın sonuçlarına göre, standart tedavi rejiminin bir parçası olmasa bile, DMAH ve takiben vita­min E tedavisinin diabetik nefropati beklenen dönemde dikkate alınması gerekir.

Kaynakça

  • Mogensen CE Microalbuminuria as a predictor of clinical diabetic nephropathy. Kidney Int 1987; 31(2): 673-89.
  • Gross JL, Azevedo MJ, Silveiro SP, Canani LH, Caramori ML, Zelrnanovitz T. Diabetic Nephropathy: Diagnosis, prevention, and treatment. Diabetes Care 2005; 28(1): 164- 76.
  • Deckert T, Feldt-Rasmussen B, Borch-Johnsen K, Jensen T, Kofoed-Enevoldsen A. Albuminuria reflects widespread vascular damage. The Steno hypothesis. Diabetologia 1988; 32(4): 219-26.
  • Gambaro G, Skrha J, Ceriello A. Glycosaminoglycan therapy for long-term diabetic complications? Diabetologia 1998; 41(8): 975-9.
  • Cohen MP, Surma ML. 35S sulfate incorporation into glom- erular basement membrane glycosaminoglycans is de- creased in experimental diabetes. J Lab Clin Med 1981; 98(5): 715 -22.
  • Gambaro G, Kinalska I, Oksa A, et al . Oral Sulodexide reduces albuminuria in microalbuminuric and macroalbu- minuric Type 1 and Type 2 diabetic patients: The Di.N.A.S. Randomized Trial. J Am Soc Nephrol 2002; 13(6): 1615- 25.
  • Gambaro G, Cavazzana AO, Luzi P, et al. Glycosaminogly- cans prevent morphological renal alterations and albuminu- ria in diabetic rats. Kidney Int 1992; 42(2): 285-91.
  • Tamsma JT, van der Woude FJ, Lemkes HHPJ. Effect of sul- fated glycosaminoglycans on albuminuria in patients with overt diabetic (type-1) nephropathy. Nephrol Dial Trans- plant 1996; 11(1): 182-5.
  • Van der Pijl JW, van der Woude FJ, et al. Danaparoid so- dium lowers proteinuria in diabetic nephropathy. J Am Soc Nephrol 1997; 8(3): 456-62.
  • Solini A, Carrara A, Barzon I, Crepaldi G. Therapy with glycosaminoglycans lowers albumin excretion rate in nonıinsulin dependent diabetic patients with microalbu- minuria. Diab Nutr Metab 1994; 7(3): 304-7.
  • Skrha J, Perusicova J, Pontuch P, Oksa A. Glycosaminogly- can sulodexide decreases albuminuria in diabetic patients. Diab Res Clin Pract 1997; 38(1): 25-31.
  • Poplawska A, Szelachowska M, Topolska J, Wysocka- Solowie B, Kinalska I. Effect of glycosaminoglycans on urinary albumin excretion in insulin-dependent diabetic patients with micro- or macroalbuminuria. Diab Res Clin Pract 1997; 38(2): 109-14.
  • Dedov I, Shestakova M, Vorontzov A, Palazzini E. A ran- domized, controlled study of sulodexide therapy for the treatment of diabetic nephropathy. Nephrol Dial Transplant 1997; 12(11): 2295-300.
  • Szelanowska M, Poplawska A, Jopdska J, Kinalska I, Grimaldi M. A pilot study of the effect of the glycosamino- glycan sulodexide on microalbuminuria in type 1 diabetic patients. Curr Med Res Opin 1997; 13(9): 539-45.
  • Ha H, Lee HB. Oxidative stress in diabetic nephropathy basic and clinical information. Curr Diab Rep 2001; 1(3): 282-7.
  • Karpen CW, Cataland S, O Doriso TM,Panganamala RV. Production of 12-hydroxyeicosatetraenoic acid and vita- min E status in platelets from type human diabetic subjects. Diabetes1985;34(6):526-3.
  • Kowluru RA, Abbas SN, Odenbach S. Reversal of hyperg- lycemia and diabetic nephropathy: effect of reinstitution of good metabolic control on oxidative stress in the kidney of diabetic rats. J Diabetes Complications 2004; 18(5):282-8.
  • Nielsen S, Schmitz A, Bacher T, Rehling M, Ingerslev J, Mogensen CE. Transcapillary escape rate and albuminuria in type II diabetes: Effects of short term treatment with I ow-molecular weight heparin. Diabetologia 1999; 42(1): 60 -7.
  • Van der Woude FJ,Van Det NF.Heparan sulphate proteo- glycans and diabetic nephropathy. Exp Nephro11997;5 (3):180-8.
  • Castellot JJ, Hoover RL, Harper PA, Karnovsky MJ. Hepa- rin and glomerular epithelial cell secreted heparin-like spe- cies inhibit mesangial cell proliferation. Am J Pathol 1985; 120(3): 427-35.
  • Hirnerova E, Krahulec B, Strbova L, et al.effect of vitamin E supplementation on microalbuminuria,lipid peroxidation and blood prostaglandins in diabetic patients. Bratis Lek Listy 2004;105(12):408-13.
  • Yokoyama M, Torita M, Yoshizawa M, Usuda R.indication of vitamin E on microalbuminuria in patients with incipient diabetic nephropathy. Diabetes Metab 2001;27(5):611-2.
  • Nakamura T, Ushiyama C, Suzuki S. Effect of taurine and vit E on mircoalbuminuria, plasma metalloproteinase and serum type IV collagen concentration in patients with dia- betic nephropathy. Nephron 1999;83(4):361-2.
  • Suzuki D, Miyata T. Carbonyl stress in pathogenesis of dia- betic nephropathy. Int Med 1999;38(4):309-14.
Toplam 24 adet kaynakça vardır.

Ayrıntılar

Birincil Dil Türkçe
Bölüm Araştırma Yazıları
Yazarlar

Hari Krishan Aggarwal Bu kişi benim

Deepak Jain Bu kişi benim

Sonia Sindhu Bu kişi benim

Raj Yadav Bu kişi benim

Yayımlanma Tarihi 1 Haziran 2011
Gönderilme Tarihi 2 Mart 2015
Yayımlandığı Sayı Yıl 2011 Cilt: 38 Sayı: 2

Kaynak Göster

APA Aggarwal, H. K., Jain, D., Sindhu, S., Yadav, R. (2011). Evaluation of role of Low Molecular Weight Heparin and Vitamin E on renal functions in patients with diabetic nephropathy. Dicle Tıp Dergisi, 38(2), 129-133. https://doi.org/10.5798/diclemedj.0921.2011.02.0001
AMA Aggarwal HK, Jain D, Sindhu S, Yadav R. Evaluation of role of Low Molecular Weight Heparin and Vitamin E on renal functions in patients with diabetic nephropathy. diclemedj. Haziran 2011;38(2):129-133. doi:10.5798/diclemedj.0921.2011.02.0001
Chicago Aggarwal, Hari Krishan, Deepak Jain, Sonia Sindhu, ve Raj Yadav. “Evaluation of Role of Low Molecular Weight Heparin and Vitamin E on Renal Functions in Patients With Diabetic Nephropathy”. Dicle Tıp Dergisi 38, sy. 2 (Haziran 2011): 129-33. https://doi.org/10.5798/diclemedj.0921.2011.02.0001.
EndNote Aggarwal HK, Jain D, Sindhu S, Yadav R (01 Haziran 2011) Evaluation of role of Low Molecular Weight Heparin and Vitamin E on renal functions in patients with diabetic nephropathy. Dicle Tıp Dergisi 38 2 129–133.
IEEE H. K. Aggarwal, D. Jain, S. Sindhu, ve R. Yadav, “Evaluation of role of Low Molecular Weight Heparin and Vitamin E on renal functions in patients with diabetic nephropathy”, diclemedj, c. 38, sy. 2, ss. 129–133, 2011, doi: 10.5798/diclemedj.0921.2011.02.0001.
ISNAD Aggarwal, Hari Krishan vd. “Evaluation of Role of Low Molecular Weight Heparin and Vitamin E on Renal Functions in Patients With Diabetic Nephropathy”. Dicle Tıp Dergisi 38/2 (Haziran 2011), 129-133. https://doi.org/10.5798/diclemedj.0921.2011.02.0001.
JAMA Aggarwal HK, Jain D, Sindhu S, Yadav R. Evaluation of role of Low Molecular Weight Heparin and Vitamin E on renal functions in patients with diabetic nephropathy. diclemedj. 2011;38:129–133.
MLA Aggarwal, Hari Krishan vd. “Evaluation of Role of Low Molecular Weight Heparin and Vitamin E on Renal Functions in Patients With Diabetic Nephropathy”. Dicle Tıp Dergisi, c. 38, sy. 2, 2011, ss. 129-33, doi:10.5798/diclemedj.0921.2011.02.0001.
Vancouver Aggarwal HK, Jain D, Sindhu S, Yadav R. Evaluation of role of Low Molecular Weight Heparin and Vitamin E on renal functions in patients with diabetic nephropathy. diclemedj. 2011;38(2):129-33.