Angiotensin receptor blocker and N-acetyl cysteine for reduction of proteinuria in patients with type 2 diabetes mellitus.
BACKGROUND
Proteinuria and albuminuria are established risk factors for progressive renal damage. Albuminuria can be effectively controlled by antihypertensive drugs that interrupt the renin-angiotensin-aldosterone system. However, the efficiency of N-acetyl cysteine (NAC) in preventing diabetic nephropathy is uncertain. Renoprotective effects of angiotensin receptor blockers and NAC in preventing or reducing of proteinuria in patients with diabetic nephropathy was studied.


METHODS
In a randomized controlled trial, 70 patients with type 2 diabetic nephropathy (proteinuria and renal insufficiency) were studied. The patients were randomly divided into two groups and were treated with losartan, 25 mg, twice per day, with and without NAC, 600 mg twice daily (study and control groups, respectively; 35 patients in each group). Urine protein was checked before treatment and after 2 months of treatment.


RESULTS
The two groups were comparable regarding gender, age, serum creatinine, and urine protein excretion levels. Proteinuria improved in both groups. The mean proteinuria level decreased more in patients with losartan and NAC; however, comparison of proteinuria between the two groups showed no significant difference after 2 months.


CONCLUSIONS
Angiotensin receptor blockers reduced proteinuria due to diabetic nephropathy, and this study failed to detect additional effect when NAC was combined with these medications.
Division of Nephrology, Department of Internal Medicine, Imam Reza Hospital, Tabriz University of Medical Sciences, Tabriz, Iran. s.rasihashemi@gmail.com
Sadreddin
S
Rasi Hashemi
Hamid
H
Noshad
Ali
A
Tabrizi
Majid
M
Mobasseri
Hamid
H
Tayebi Khosroshahi
Masoumeie
M
Heydarnejad
Mohammad Reza
MR
Khalaj
Naser
N
Aghamohammadzadeh
D000111:Acetylcysteine / Q000627:therapeutic use*; D000328:Adult; D000368:Aged; D047228:Angiotensin II Type 1 Receptor Blockers / Q000627:therapeutic use*; D003924:Diabetes Mellitus, Type 2 / Q000150:complications* / Q000652:urine; D003928:Diabetic Nephropathies / Q000188:drug therapy* / Q000652:urine; D004359:Drug Therapy, Combination; D005260:Female; D016166:Free Radical Scavengers / Q000627:therapeutic use*; D006801:Humans; D019808:Losartan / Q000627:therapeutic use*; D008297:Male; D008875:Middle Aged; D011507:Proteinuria / Q000188:drug therapy* / Q000209:etiology; D018709:Statistics, Nonparametric
D047228:Angiotensin II Type 1 Receptor Blockers; D016166:Free Radical Scavengers; D019808:Losartan; D000111:Acetylcysteine