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TİP 2 DİABETİK HASTALARDA NEFROPATİNİN BAŞLANGİÇ DÖNEMİNDE PLAZMA ENDOTELİN-I DÜZEYLERİ

ENDOTHELÎN 1 LEVELS IN TYPE II DIABETIC PATIENTS DURING THE INITIAL PHASE OF NEPHROPATHY

Journal Name:

  • Türk Nefroloji, Diyaliz ve Transplantasyon Dergisi

Publication Year:

  • 1994

Key Words:

Keywords (Original Language):

Author NameUniversity of AuthorFaculty of Author
Abstract (2. Language): 
Nefropathy is a common complication of diabetes mellitus. During the initial phase of nephropathy there is an increase in renal plasma flow and filtration fraction. Vasoactive amines are probably involve in the of diabetic nephropathy. Tlıis study was planned to show the role of Endothelin 1 on diabetic nephropathy during the microalbuminuria phase in Type II diabetic patients. 16 Type II diabetic patients with mild to moderate hypertension and microalbuminuria were included in the study population. Patients were treated with enalapril maleate and dose adjustments were made according to blood pressure control. Plasma Endothelin 1 levels were studied at the beginning and after an average follow up of 3.4 months and compared with the healthy control group. Tlie initial microalbuminuria level of 49.1±35.5mg/day decreased to 18.8±15.9mg/day (p<0.005), the initial systolic blood pressure 162 + 19.4 mmHg decreased to 130.6±12.4 mmHg (p<0.001) and the initial diastolic blood pressure 84.1±10.5 mmHg decreased to 76.9±8.5 mmHg (p<0.05) all being statistically significant. TJiere were no statistically significant changes in Haemoglobin Ale levels and lipid profiles during the study. Plasma renin activity was 1.97±2.3ng/ml/hour initially, 6.40±8.98ng/ml/ hour at the and of the study, and 3.44±2.52 ng/ml/hour is the control group, being statistically insignificant. Tlie plasma endothelin 1 level was 7.55±7.82 pmol/ml initially, 9.20±4.34 pmol/ml at the end of the study, and 14.39±6.01 pmol/ml in the control group. There was a statistical difference between the patients initial levels and control group levels (p<0.01). As a result, in Type II diabetic patients, during the microalbuminuria phase of nephro-pathy, endothelin levels were found to be low. Although there was a significant decrease in microalbuminuria following enalapril maleate therapy there was no change in endot- helin 1, the hypothesis supporting that endothelin is not involved in the pat-hogenesis of nephropathy in Typell diabetic patients.
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Abstract (Original Language): 
Diabetik hastalarda nefropati sık görülen bir komp-likasyondur. Nefropati gelişiminde erken dönemde renal plazma akımı ve filtrasyon fraksiyonunun arttığı bilinmektedir. Bu olayda çeşitli vazoaktif maddelerin rol oynadığı düşünülmektedir. Bu çalışma Tip 2 Diabetik hastalarda, nefropatinin mikroalbüminüri döneminde Endotelin V in rolünü araştırmak amacıyla yapılmıştır. Çalışmaya 16 Tip 2 Diabetik hasta alındı. Hastala¬rın mikroalbüminüri ve hafif, orta şiddette hipertansi¬yonları vardı. Hastalara kan basınçlarına göre dozu ayarlanmak üzere enalapril maleat tedavisi başlandı. Çalışma başlangıcında ve ortalama 3.4 aylık takip so¬nunda alınan örneklerden endotelin 1 düzeyleri çalışıl¬dı ve yaş cins uyumlu sağlıklı kontrol grubu ile karşı¬laştırıldı. Tedavi başlangıcında ortalama 49.1 ±35.5 mg/gün olan mikroalbüminüri, enalapril tedavisi ile 18.8±15.9 mg/gün değerine düştü (p<0.005). Sistolik kan basıncı 162 ±19.4 mmHg iken tedavi ilel30±12.4 mmHg (p<0.001) ve diastolik kan basın¬cı 84.1±10.5 mmHg iken tedavi ile 76.9 ±8.5mınHg (p<0.05) değerine düştü. Çalışma süresince hastaların glukolize hemoglobin ve lipid profilleri sabit kaldı, be¬lirgin metabolik değişiklik olmadı. Plazma renin aktivi-tesi çalışma başlangıcında 1,97+2.3 ng/ml/saat, çalış¬ma sonunda 6.40 + 8.98ng/ml/saat ve kontrolgrubun¬da 3.44±2.52ng/ml/saat olarak ölçüldü, her ölçüm arasında istatistiksel farklılık yoktu. Plazma endotelin düzeyi çalışma başlangıcında 7.55 + 7.82 pmol/ml bu¬lundu ve bu değer kontrol grubunda 14.39 + 6.01 pmol/ml ölçüldü, aradaki fark anlamlıydı (p<0.01). Çalışma sonunda ölçülen endotelin düzeyi 9.20+4.34 pmol/ml ise başlangıç değerlerine ve kontrol grubuna göre istatistiksel fark taşımıyordu. Sonuç olarak Tip 2 Diabetik hastalarda mikroalbüminüri döneminde plaz¬ma endotelin düzeyleri düşük bulunmuştur, enalapril tedavisi ile mikroalbüminüri belirgin olarak azaldığı halde endotelin 1 düzeyinde değişiklik olmaması dia-betik nefropati patofızyolojisinde endotelinin belirgin rolünün olmadığını düşündürmektedir.
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