Abstract
Background: Diabetic nephropathy characterized by persistent albuminuria is the single leading cause of end-stage renal disease. Renin angiotensin system (RAS) is considered to be involved in most of the pathological processes that result in diabetic nephropathy. The progression of diabetic nephropathy can be retarded by ACE inhibitors (ACEIs) in patients with type 2 diabetes. The aim of our study was to find out the antiproteinuric and renoprotective effect of Ramipril, an angiotensin-converting enzyme (ACE) inhibitor, in diabetic nephropathy patients.
Materials and Methods: The study was conducted on 63 patients of diabetic nephropathy of type 2 diabetes mellitus aged between 31-64 years, selected from indoor ward and subsequently followed up as outdoor patients of medicine department of Narayan Medical College and Hospital, Sasaram, Bihar. Treatment with Ramipril (ACEI) was initiated after proper control of blood pressure and plasma glucose. Before treatment and after 2 months of continuous therapy with Ramipril, proteinuria and GFR estimation by creatinine clearance method were assessed.
Results: Ramipril treatment improved renal function. After proper control of blood pressure and glycemia, overall GFR improved from 52.26±9.12 to 60.26±13.76 which further improved to 70.26±15.38 ml/min after ACE-inhibitor therapy. Overall proteinuria which was 1898.53±1348.80 mg/24hr before control of BP and glycemia reduced to 1614.26±1163.37 mg/24 hr after control of BP and glycemia and further decreased followed ACE-inhibitor therapy to 1373.26±1289.16 mg/24hr.
Conclusions: It was observed that proper control of glycemia and BP may lead to substantial improvement in GFR as well as proteinuria in type 2 diabetic patients with diabetic nephropathy. ACE-inhibitor institution following proper control of BP and glycemia may further improve the GFR and reduce proteinuria.
Keywords: Angiotensin-converting enzyme inhibitors, diabetic nephropathy, type 2 diabetes mellitus
References
- Ayodele OE, Alebiosu CO, Salako BL: Diabetic nephropathy: a review of the natural history, burden, risk factors and treatment. J Natl Med Assoc 2004;96:1445–1454,
- Unnikrishnan RI, Rema M, Pradeepa R, Deepa M, Shanthirani CS, Deepa R. et al. Prevalence and risk factors of diabetic nephropathy in an urban South Indian population: the Chennai Urban Rural Epidemiology Study (CURES 45)Diabetes Care. 2007;30:2019–24.
- Lozano-Maneiro L, Puente-García A. ReninAngiotensin-Aldosterone System Blockade in Diabetic Nephropathy. Present Evidences. NavarroGonzález JF, Luis D, eds. Journal of Clinical Medicine. 2015; 4:1908-37.
- Rodríguez-Iturbe B, Pons H, Herrera-Acosta J, Johnson RJ. Role of immunocompetent cells in nonimmune renal diseases. Kidney Int 2001; 59: 1626-1640.
- Ruiz-Ortega M, Lorenzo O, Rupérez M, Esteban V, Mezzano S, Egido J. Renin-angiotensin system and renal damage: emerging data on angiotensin II as a proinflammatory mediator. Contrib Nephrol 2001; 135: 123-33.
- Roscioni S.S., Heerspink H.J., Zeeuw D. The effect of RAAS blockade on the progression of diabetic nephropathy. Rev. Nephrol. 2014; 10:77–87.
- Gheith O, Farouk N, Nampoory N, Halim MA, Al-Otaibi T. Diabetic kidney disease: worldwide difference of prevalence and risk factors.Journal of Nephropharmacology. 2016;5(1):49-56.
- Fowler MJ. Microvascular and macrovascular complications of diabetes. Clin Diabetes 2008; 26:77-82.
- Sandhu GA, Tahir GA, Ahmad Z, Anjum AM. Microalbuminuria; comparison of losartan potassium and lisinopril in treatment of patients with type ii diabetes mellitus”. Professional Med J 2017;24(2):221-227.
- Harris R.Angiotensin-Converting Enzyme Inhibition in Diabetic Nephropathy: It’s All the RAGE. Am. Soc. Nephrol. 2005 16: 2251-2253.
- Josephine M. Forbes, Mark E. Cooper, Matthew D. Oldfield, and Merlin C. Thomas
Role of Advanced Glycation End Products in Diabetic Nephropathy
Am. Soc. Nephrol. 2003 14: S254-S258.
- Singh V K, Mishra A, Gupta K K, Misra R, Patel M L, Shilpa. Reduction of microalbuminuria in type-2 diabetes mellitus with angiotensin-converting enzyme inhibitor alone and with cilnidipine. Indian J Nephrol 2015;25:334-8.
- Definition and diagnosis of diabetes mellitus and intermediate hyperglycemia: November 2005 report of a WHO/IDF consultation.
- Diabetic Nephropathy. American Diabetes Association. Diabetes Care, , Supplement 1; January 2003: 26;S94- S98.
- Deepa, M. et al. Knowledge and awareness of diabetes in urban and rural India: The Indian Council of Medical Research India Diabetes Study (Phase I): Indian Council of Medical Research India Diabetes 4. Indian J. Endocrinol. Metab. 18, 379–385 (2014).
- Anjana, R. M. et al. Prevalence of diabetes and prediabetes (impaired fasting glucose and/or impaired glucose tolerance) in urban and rural India: phase I results of the Indian Council of Medical Research-INdia DIABetes (ICMR-INDIAB) study. Diabetologia 54, 3022–3027 (2011).
- Adler AI, Stevens RJ, Manley SE, Bilous RW, Cull CA, Holman RR; UKPDS GROUP. Development and progression of nephropathy in type 2 diabetes: The United Kingdom Prospective Diabetes Study (UKPDS 64). Kidney Int 2003;63:225-32.
- Chandy A, Pawar B, John M , Isaac R. Association between Diabetic Nephropathy and Other Diabetic Microvascular and Macrovascular Complications. Saudi J Kidney Dis Transplant 2008;19(6):924-928.
- Rossing K,Christensen P.K, Hovind P, Tarnow L, Rossing P, Parving H. Progression of nephropathy in type 2 diabetic patients. Kidney International (2004) 66 (4) , 1596-1605.
- Knowler WG, Bennetf PH, Nelson RG: Prediabetic blood pressure predicts albuminuria after development of NIDDM. Diabetes 37(Suppl): 120A, 1988.
- Heart Outcomes Prevention Evaluation Study Investigators.Effects of ramipril on cardiovascular and microvascular outcomes in people with diabetes mellitus: results of the HOPE study and MICRO-HOPE substudy. Lancet 2000;355:253–9.
- Kasiske BL, Kalil RS, Ma JZ, Liao M, Keane WF. Effect of antihypertensive therapy on the kidney in patients with diabetes: A meta-regression analysis. Ann Intern Med 1993;118:129-38
Corresponding Author
Faiyaz Ahmad Ansari
Assistant Professor, Department of Medicine,
Indira Gandhi Institute of Medical Sciences, Patna, Bihar.
Email: This email address is being protected from spambots. You need JavaScript enabled to view it.
DOI: https://dx.doi.org/10.18535/jmscr/v6i4.86
