Renoprotective evaluations of different angiotensin inhibitors on Dia- betic Nephropathy in Rats Cutaneous Leishmania in Wadi Hadramout, Yemen

International Journal of Pharmacy Practice & Drug Research

To evaluate the effect of Angiotensin Converting Enzyme Inhibitors (ACEI) and Angiotensin Receptor Blockers (ARB) in glycemic control among the Diabetic Nephropathy patients. A cross sectional study was done among the type 2 diabetics presenting consecutively to a diabetes specialty hospital with Diabetic Nephropathy. 35 patients were studied over a period of five months Patients were subjected to the clinical and laboratory investigations. The patient had average age of 57.1 years and the average duration of diabetes mellitus was 9.35 years and patients are grouped into two as ACEI and ARB. Both the groups are also treated for glycemic control with Gliclazide-Metformin combination (48.57%) and Glimepride-Metformin combination (28.57%) & others (22.86%). We found that at initial visit, average Blood Glucose (F) was 132mg/dl & 134mg/dl and Average Blood Glucose (PP) was 211mg/dl & 226mg/dl in ACEI & ARB groups respectively. The Initial average HbA1c values are 8.33 % & 8.71 % in ACEI & ARB groups respectively. On subsequent visits it is found to be reduced to 127mg/dl & 115mg/dl of Blood Glucose (F) and 208mg/dl & 189mg/dl of Blood Glucose (PP) in both groups respectively and HbA1c is also found to be reduced to 8.17 and 7.08 in both groups respectively. Thus we conclude that among the two groups ARB group has significant effect on glycemic control compared to ACEI group.

American Journal of Kidney Diseases, 2013

Blockade of the renin-angiotensin system with angiotensin-converting enzyme inhibitors or angiotensin II receptor blockers has been shown to lessen the rate of decrease in glomerular filtration rate in patients with diabetic nephropathy. A multicenter open-label randomized controlled trial to compare the efficacy of combining the angiotensin-converting enzyme inhibitor lisinopril and the angiotensin II receptor blocker irbesartan with that of each drug in monotherapy (at both high and equipotent doses) in slowing the progression of type 2 diabetic nephropathy. 133 patients with type 2 diabetic nephropathy (age, 66 ± 8 years; 76% men) from 17 centers in Spain. Patients were randomly assigned (1:1:2) to lisinopril (n = 35), irbesartan (n = 28), or the combination of both (n = 70). The primary composite outcome was a >50% increase in baseline serum creatinine level, end-stage renal disease, or death. Baseline values for mean estimated glomerular filtration rate and blood pressure were 49 ± 21 mL/min/1.73 m(2) and 153 ± 19/81 ± 11 mm Hg. Mean geometric baseline proteinuria was protein excretion of 1.32 (95% CI, 1.10-1.62) g/g creatinine. After a median follow-up of 32 months, 21 (30%) patients in the combination group, 10 (29%) in the lisinopril group, and 8 (29%) in the irbesartan group reached the primary outcome. HRs were 0.96 (95% CI, 0.44-2.05; P = 0.9) and 0.90 (95% CI, 0.39-2.02; P = 0.8) for the combination versus the lisinopril and irbesartan groups, respectively. There were no significant differences in proteinuria reduction or blood pressure control between groups. The number of adverse events, including hyperkalemia, was similar in all 3 groups. The study was not double blind. The sample size studied was small. We were unable to show a benefit of the combination of lisinopril and irbesartan compared to either agent alone at optimal high doses on the risk of progression of type 2 diabetic nephropathy.

Seminars in Nephrology, 2004

Nephropathy is a critical problem encountered in management of diabetes mellitus. Some experimental and clinical studies describe a possible physiological role of angiotensin II (AII) and calcium channels in the pathogenesis of diabetic complications. Furthermore, Experimental studies reported that the antihypertensive agents have been shown to exert variable effects on renal injury in experimental renal disease models. Therefore the aim of this study was to study the possible renoprotection and anti-oxidant effects of the angiotensin receptor blocker (ARB). Olmesartan administered for 16 weeks in a Deoxycorticosterone acetate (DOCA)-salt treated diabetic model in albino rats. Sixty male albino rats were divided in these groups randomly: untreated control rats [ group 1, N=12], fourty-eight rats were rendered hypertensive by DOCA salt treatment injected Sc twice/week for 2 weeks, then they were subdivided to group 2,3,4,5 [ N in each =12] as follows: [ group 2] was untreated diabetic rats , and [group 3,4,5] were diabetic rats treated with olmesartan 10 , 20, 40 mg/kg/ day intragastric respectively]. Rats were rendered diabetic by streptozotozin after overnight fast. Results suggest that the tested doses of olmesartan could play an important renoprotective and antioxidant role in a co-morbid model of hypertension with type 1 diabetes model of albino rats .

International Journal of Pharmaceutical Sciences and Nanotechnology, 2011

Renin angiotensin system plays a major role in the pathology of progressive Diabetic Nephropathy. In the present study, the renoprotective effects of low dose combined novel direct renin inhibitor-aliskiren and angiotensin II type 1 receptor blocker (ARB)-valsartan were estimated and compared with monotherapy in wistar rats. Rats were divided into 5 groups: control, diabetic control, diabetic rats treated with aliskiren (10 mg/kg/day), valsartan (20 mg/kg/day) and combination of aliskiren and valsartan (5 mg/kg/day, 10mg/kg/day respectively). Clinical characteristics like proteinuria, serum creatinine and renal histopathological studies like glomerulosclrotic index, tubulointerstitial fibrosis were estimated and compared between all diabetic rats. Results showed that combination therapy of aliskiren and valsartan was more effective than the monotherapy in progressive diabetic nephropathy.

Hong Kong Journal of Nephrology, 2007

Diabetes management, 2012

New England Journal of Medicine, 2001

Kidney International, 2003

Kidney International, 2019