The effect of N-acetylcysteine on proteinuria and markers of tubular injury in non-diabetic patients with chronic kidney disease. A placebo-controlled, randomized, open, cross-over study.
BACKGROUND
Inhibition of the renin-angiotensin-aldosterone system with angiotensin-converting enzyme inhibitors (ACEI) and/or angiotensin II subtype 1 receptor antagonists (ARB) constitutes a strategy in the management of patients with chronic kidney disease. There is still no optimal therapy which can stop the progression of chronic kidney disease. Antioxidants such as N-acetylcysteine (NAC) have been reported as a promising strategy in this field.


METHODS
In a placebo-controlled, randomized, open, 2-period cross-over study, we evaluated the influence of NAC (1,200 mg/day) added to renin-angiotensin-aldosterone system blockade on proteinuria and surrogate markers of tubular injury and renal fibrosis in 20 non-diabetic patients with proteinuria (0.4-6.36 g/24 h) with normal or decreased kidney function (estimated glomerular filtration rate 61-163 ml/min). Subjects entered the 8-week run-in period during which the therapy using ACEI and/or ARB was established with blood pressure below 130/80 mm Hg. Next, patients were randomly assigned to 1 of 2 treatment sequences: NAC/washout/placebo or placebo/washout/NAC. Clinical evaluation and laboratory tests were performed at the randomization point and after each period of the study.


RESULTS
No significant changes in laboratory tests were observed.


CONCLUSIONS
NAC had no effect on proteinuria, surrogate markers of tubular injury or renal fibrosis in non-diabetic patients with chronic kidney disease.
Renke
Marcin
M
Department of Nephrology, Transplantology and Internal Medicine, Medical University of Gdansk, Gdansk, Poland. mrenke@amedec.amg.gda.pl
Tylicki
Leszek
L
Rutkowski
Przemysław
P
Larczyński
Wojciech
W
Aleksandrowicz
Ewa
E
Lysiak-Szydłowska
Wiesława
W
Rutkowski
Bolesław
B
D000111:Acetylcysteine / Q000008:administration & dosage* / Q000494:pharmacology / Q000627:therapeutic use; D000328:Adult; D000806:Angiotensin-Converting Enzyme Inhibitors; D000975:Antioxidants / Q000627:therapeutic use; D015415:Biomarkers / Q000032:analysis; D002908:Chronic Disease; D018592:Cross-Over Studies; D004359:Drug Therapy, Combination; D005260:Female; D005355:Fibrosis / Q000188:drug therapy; D006801:Humans; D007674:Kidney Diseases / Q000188:drug therapy*; D007684:Kidney Tubules / Q000187:drug effects / Q000473:pathology*; D008297:Male; D011507:Proteinuria / Q000188:drug therapy*; D016896:Treatment Outcome
D000806:Angiotensin-Converting Enzyme Inhibitors; D000975:Antioxidants; D015415:Biomarkers; D000111:Acetylcysteine