Diabetic nephropathy: new capacities of pharmacological correction

The present study aimed to develop the effective regimen of drug prevention of diabetic nephropathy. The efficacy of the angi­otensin-converting enzyme (ACE) inhibitorfozinopril and the bi­ological response modifier glutoxim used in 86 patients with type 1 diabetes mellitus was evaluated by 24-hour blood pressure monitoring, by evaluating renal hemodynamics (radioisotopic re­nography; the Jaffe test for blood creatinine; the Rehberg- Tareyev test), by measuring the content of capillary blood glucose by the glucose oxidase test, the level of Hb A_k by the colorimetric assay, the urinary concentration of protein by the sulfosalicylic acid test, by examiming the time course of changes in the albumin/creatitine in the morning urinary sample. The assessment of the hormonal profile included immunoradiometric assay of the levels of cortisol, ardenocorticotropic hormone, transport proteins or cortisol/albumin and transcortin. The evaluation of the pa­tients ’ status involved isolation of lymphocytes, measurement of IgG, IgA, and IgM, circulating immune complexes, detecton of cell membrane surface markers, synthesis of interleukin-1 and tissue necrosis factor-a. The combined use of fozinopril and glu­toxim was found to be highly effective in normalizing renal he­modynamic parameters in type 1 diabetes mellitus and arterial hypertension (p < 0.001) and in eliminating microalbuminuria (p < 0.001). Glutoxim promoted normalization of the hormonal and metabolic profile in the patients by significantly ameliorating the symptoms of imunodeficiency. The possible mechanism of poten­tiating the nephroprotective effect of fozinopril with glutoxim in­cluded into the treatment regimen was the low rates of apoptotic processes in the glomerular and renal epitheliocytes due to to the elimination of their triggering hormonal, metabolic, immune, and hemodynamic factors.

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