Effects of N-acetyl cysteine and magnesium on oxidative stress in streptozotocin induced - diabetic nephropathy in rats

Increased production of reactive oxygen species [ROS] in diabetes may be a common pathway linking diverse pathogenic mechanisms of diabetic vascular complications, including nephropathy. Assessment of the oxidative stress production pathway is therefore important for the prediction and prevention of diabetic complications. this study was designed to evaluate the effects of N-acetyl cysteine [NAC] supplementation alone or combined with magnesium [Mg], on oxidative stress in streptozotocin-induced diabetic nephropathy in rats, Sprague Dawley rats [n=40] were rendered diabetic with streptozotocin [STZ] and followed consecutively for 12-weeks with non-diabetic controls [n=10]. Diabetic rats were subdivided into equal three subgroups DM4 NAC group treated with NAC [440 mg/kg/day], DM+Mg group treated with Mg [0.6%], or NAC+Mg diabetic group treated with a combination of both drugs. The following parameters were measured at week 12 in similar rats chosen randomly from each group: body weight [BW], kidney weight [KW], 24-hour urinary albumin excretion [UAE], biochemical indexes including blood glucose, serum creatinine [SCr], antioxidant enzymes including superoxide dismutase. [SOD], catalase [CAT], reduced glutathione, lipid peroxidation product as malondialdehyde in plasma [MDAp]. At weeks 12, blood glucose and kidney weight to body weight ratio were notably increased in the diabetic groups compared with those in the control group with significant decrease in DM+Mg and NAC+ Mg treated groups in comparison to the diabetic untreated group. There were no significant differences of SCr among all groups. Plasma MDA were significantly increased in the diabetic groups, while SOD, CAT and reduced glutathione were significantly decreased compared with those in the control group. Also, UAE was also increased in the diabetic groups. Pre-treatment with NAC, Mg or both produced significant decrease of lipid peroxidation production and increase of antioxidant enzymes. Correlation analysis and regression analysis shown that plasma MDA was increased while SOD, CAT and reduced glutathione in plasma were decreased with elevation of UAE. Increased lipid peroxidation and decreased antioxidant enzymes in plasma may play a role in the progression of diabetic nephropathy. NAC and Mg may ameliorate these changes to protect kidney from oxidative lesion in diabetes

Intrarenal reflux: a retrospective and comparative study

Intrarenal reflux [IRR] has been considered a classic indication for surgical intervention in cases with vesicoureteric reflux [VUR]. During 1990s, the natural history of VUR and its spontaneous disappearance especially during the first years of life became clearer, leading to the concept of conservative treatment even for the moderate and high grades. This retrospective study aimed at finding if there is an increased incidence of pyelonephritis in spite of proper antibiotic prophylactic treatment of IRR and whether the presence of IRR carries a higher risk in patients with VUR, which dictates earlier surgical intervention. One hundred and eighty five patients less than 5 years old with VUR were operated upon between 1989 and 2000 at the Children's Hospital of Trousseau in Paris. Thirteen [7%] patients [9 females and 4 males] with IRR were diagnosed [Group A]. These children were compared with 13 other children with the same age, sex, and grade of reflux but without IRR [control group B] to find out the impact of IRR on the pattern of presentation and prognosis. The indication of surgical intervention was pyelonephritis under medical treatment [1: 3 episodes] in all patients in Group A except 4 [70%]; while for Group B patients, this indication of surgical intervention was present in 6 infants [1: 2 episodes] [46%] .The frequency of pre-operative renal scarring [1-3 scars] was higher in group A than in group B [4 cases, 31%, versus 3 cases, 23%]. The results were in favour of higher incidence of pyelonephritis at presentation and in patients under medical treatment. Renal scarring in the pre-operative period was more frequent in patients with IRR. A prospective multicentric study with greater number of patients suffering of IRR is needed, and prolonged surveillance with systematic radio99mTc-DMSA renoscintigraphy scan is highly recommended