RESUMEN
BACKGROUND: Albuminuria is the best and most readily available marker for glomerular damage and progressive renal function loss in patients with diabetic nephropathy. Recently, administration of the oral glycosaminoglycan sulodexide (a mixture of 80% fast-moving heparin and 20% dermatan sulphate) was shown to effectively decrease albumin excretion rate in diabetics with nephropathy. AIMS: To evaluate whether the hypoalbuminuric effect of sulodexide is associated with improvement of the renal vascular or tubule function. METHODS: Forty-five type 1 diabetic patients, affected by diabetic nephropathy with albuminuria for at least 5 years, were randomly allocated to sulodexide or untreated. Those allocated to sulodexide were given 100 mg of sulodexide daily for 120 days. Renal vascular function (DIR) and N-acetyl-beta-D-glucosaminidase (NAG) excretion were estimated before and at the end of the study, the former in thesulodexide group only. DIR was measured as two Cr(cl) lasting 120 min (before and during 2 mug/kg b.w. i.v. dopamine). RESULTS: The analysis of trends during the study demonstrated a marked reduction of albuminuria in the sulodexide group (from 126.1 +/- 15.41 to 93.6 +/- 13.7 mg/day). DIR rose from 13.2 +/- 2.1% to 15.44 +/- 1.9% (relative increase: +16.9%), and NAG excretion showed a decreasing trend decreased in the sulodexide group only (from 5.1 +/- 0.62 to 4.7 +/- 0.40 U/g(creat)). CONCLUSION: The findings presented in this study indicate for the first time that orally available sulodexide may favorably affect the renal vascular function in type 1 diabetic patients with nephropathy and microalbuminuria. The effect of sulodexide on NAG is strongly influenced by the baseline NAG values, with a significant NAG reduction in the patients with the highest baseline NAG values.
Asunto(s)
Anticoagulantes/farmacología , Nefropatías Diabéticas/tratamiento farmacológico , Endotelio Vascular/efectos de los fármacos , Glicosaminoglicanos/farmacología , Glomérulos Renales/efectos de los fármacos , Acetilglucosaminidasa/orina , Adulto , Albuminuria/tratamiento farmacológico , Anticoagulantes/uso terapéutico , Nefropatías Diabéticas/fisiopatología , Femenino , Tasa de Filtración Glomerular , Glicosaminoglicanos/uso terapéutico , Humanos , Glomérulos Renales/irrigación sanguínea , MasculinoRESUMEN
Arterial hypertension is one of the most important factors leading to chronic graft nephropathy and causing cardiovascular complications following renal transplantation. Effective control of the blood pressure seems to be vital for satisfactory long-term graft and patient survival. The objective of the study was to evaluate possible factors associated with persistent or de novo hypertension in patients following allogenic cadaveric kidney transplantation. 325 patients with minimum follow-up period of 6 months and only on cyclosporine-based immunosuppression were analyzed. Two groups of patients were compared: group A included normotensive or "well controlled hypertension" patients while group B consisted of patients with uncontrolled hypertension. Results revealed that patients with ill-controlled or uncontrolled hypertension received kidneys from older donors, mean creatinine level within 6 months post-transplant was significantly higher and hypertension was associated with higher rate of urinary tract infections in this group.
Asunto(s)
Análisis Factorial , Rechazo de Injerto/epidemiología , Hipertensión/epidemiología , Trasplante de Riñón/efectos adversos , Adolescente , Adulto , Factores de Edad , Anciano , Cadáver , Creatinina/sangre , Ciclosporina/sangre , Ciclosporina/uso terapéutico , Femenino , Humanos , Inmunosupresores/uso terapéutico , Trasplante de Riñón/fisiología , Lípidos/sangre , Masculino , Persona de Mediana Edad , Estudios Retrospectivos , Donantes de Tejidos , Insuficiencia del Tratamiento , Resultado del Tratamiento , Infecciones Urinarias/epidemiologíaRESUMEN
The rate of progression of renal disease depends on many factors including serum lipids and tubulo-interstitial injury. Aim of the study was to see whether fish-oil therapy may affect serum lipids and NAG excretion with urine (a marker of tubular cell damage) in humans with renal disease. The effects of dietary fish-oil fatty acids on the serum lipids, NAG urinary excretion and serum arachidonic acid concentration were examined in thirteen primary glomerulonephritic patients with proteinuria and normal renal function. The regular diet enriched with 1650 mg n-3 polyunsaturated fatty acids (18%: 20:5; n-3 EPA and 12%: 22:5; n-3 DHA) was ingested for three months. At the end of fish-oil enriched diet neither creatinine clearance nor urinary protein excretion changed significantly. But serum concentration of HDL and arachidonic acid increased (48.0 +/- 15 vs. 52.0 +/- 14; p < 0.05), (0.47 +/- 0.13 vs. 0.72 +/- 0.29; p < 0.01), respectively. Simultaneously urine NAG excretion and serum LDL decreased (11.2 +/- 7.1 vs. 10.3 +/- 7.3; p < 0.05), (163.0 +/- 57 vs. 149.0 +/- 51, p < 0.01), respectively. We presume that fish-oil supplementation may have a beneficial effect on renal tubular cells in humans and it could be linked with arachidonic acid metabolism.
Asunto(s)
Acetilglucosaminidasa/orina , Aceites de Pescado/uso terapéutico , Enfermedades Renales/dietoterapia , Riñón/fisiología , Adulto , Ácido Araquidónico/sangre , HDL-Colesterol/sangre , LDL-Colesterol/sangre , Femenino , Tasa de Filtración Glomerular/efectos de los fármacos , Humanos , Riñón/efectos de los fármacos , Enfermedades Renales/complicaciones , Masculino , Persona de Mediana Edad , Proteinuria/complicacionesRESUMEN
The effect of catecholamines on the regulation of extra-renal potassium homeostasis is well known in some pathological conditions such eg. chronic renal failure. However, the role of catecholamines on potassium homeostasis in acute renal failure has not been established yet. There are only scarce amount literature on this issue showing that both clinical and experimental acute renal failure plasma catecholamines are elevated. Presumably, acute renal failure associated hyperkalemia is ameliorated by raised plasma catecholamine concentration.