Renin-Angiotensin system inhibitors reduce serum asymmetric dimethylarginine levels and oxidative stress in normotensive patients with chronic kidney disease.
OBJECTIVE
The purpose of our study was to elucidate the relationship between asymmetric dimethylarginine (ADMA) and intrarenal lesions and to determine the effect of renin-angiotensin system inhibitors (RAS-Is) on serum ADMA levels, nitric oxide (NO) synthesis and oxidative stress in normotensive patients with chronic kidney disease (CKD).


METHODS
This study included 23 normotensive patients with chronic glomerulonephritis and normal or mildly impaired renal function who underwent renal biopsy. We evaluated the relationship between serum ADMA levels and intrarenal lesions, and examined renal function, urinary protein excretion, ADMA levels, NO synthesis, oxidative stress and blood pressure (BP) before and 3 months after starting the treatment with RAS-Is.


RESULTS
Serum ADMA levels were correlated only with arterial intimal fibroplastic thickness. Despite comparable renal function and BP, serum ADMA levels and excretion of urinary protein excretion significantly decreased, and urinary NO metabolite excretion significantly increased after starting the treatment with RAS-Is. Oxidative stress markers also tended to be reduced by the treatment.


CONCLUSIONS
These findings suggest that RAS-Is improve the NO system and decrease oxidative stress in normotensive patients with CKD. In addition, ADMA may be associated with intrarenal lesions and can be a useful marker for the effects of treatment in the early stages of CKD.
Division of Nephrology and Kidney Center, Kobe University Graduate School of Medicine, Kobe, Japan.
Hideki
H
Fujii
Division of Nephrology and Kidney Center, Kobe University Graduate School of Medicine, Kobe, Japan.
Keiji
K
Kono
Division of Nephrology and Kidney Center, Kobe University Graduate School of Medicine, Kobe, Japan.
Kentaro
K
Nakai
Division of Nephrology and Kidney Center, Kobe University Graduate School of Medicine, Kobe, Japan.
Shunsuke
S
Goto
Division of Diagnostic Molecular Pathology, Kobe University Graduate School of Medicine, Kobe, Japan ; Division of Molecular Pathology, Ehime University Graduate School of Medicine, Toon, Isehara, Japan.
Riko
R
Kitazawa
Division of Nephrology and Kidney Center, Kobe University Graduate School of Medicine, Kobe, Japan ; Division of Nephrology and Metabolism, Department of Internal Medicine, Tokai University School of Medicine, Isehara, Japan.
Masafumi
M
Fukagawa
Division of Nephrology and Kidney Center, Kobe University Graduate School of Medicine, Kobe, Japan.
Shinichi
S
Nishi
Asymmetric dimethylarginine; Chronic kidney disease; Oxidative stress; Renin-angiotensin system inhibitor