Proteinuria a target for reno-protection in hypertensive patients with type 2 diabetic nephropathy

ABSTRACT

To study the response of angiotensin II [ATI] receptor antagonist ARE [Losartan] as monotherapy in diagnosed hypertensive, non-insulin dependent diabetes mellitus [NIDDM] patients with nephropathy [albuminuria]. Department of pharmacology, Basic Medical Sciences Institute [BMSI], Jinnah Post Graduate Medical Centre [JPMC], Karachi. This study is a randomized trial used to examine the effects of ARB [Losartan] on the renal outcome of 20 diagnosed cases of hypertensive noninsulin dependent diabetes [NIDDM] with base line proteinuria. 20 normal subjects were also selected as control group. Baseline albuminuria is almost linearly related to renal outcome, and is the strongest predictor among all measured well-known baseline risk parameters. The changes in albuminuria in the first 3 months of therapy are roughly linearly related to the degree of long-term renal protection. ARB [Losartan] showed 58% [P<0.001] reduction in proteinuria, 4.7% reduction in serum urea, 7.06% [P<0.01] reduction in serum creatinine, creatinine clearance by 4.72%, serum potassium increases by 5.07% [P<0.01] and FBS reduced by 33.29% I [P<0.001]. Baseline to final change for SBP as well as for, DBP was significantly reduced i.e.19.20% [P<0.001] and 16.16%[p<0.001] respectively. In conclusion, albuminuria should be considered a risk marker for progressive loss of renal function in hypertensive type 2 diabetic patients with nephropathy, as well as a target for therapy. Reduction of residual albuminuria to the lowest achievable level should be viewed as a goal for future renoprotective treatments