Vol. 8, No 1, 2001 pp. 26 - 30
UC 612.12
THE EFFECTS OF THE THERAPY
WITH NATURAL GLYCOSAMINOGLYCANS (SULODEXIDE)
ON PROTEINURIA IN DIFFERENT TYPES OF GLOMERULONEPHRITIS
Gheorghe Gluhovschi1, Adalbert Schiller1,
Marius Raica2, Ligia Petrica1, Virginia Trandafirescu1,
Silvia Velciov1, Gheorghe Bozdog1, Carmen
Patrascu1, Cristina Gluhovschi1
University of Medicine and Pharmacy, County Hospital, Timişoara, Romania
1Dpt. of Nephrology, 2Dpt. of Histology, Timişoara,
Romania
Summary. Alterations of the glycosaminoglycans (GAG) from the glomerular
basement membrane have been demonstrated in glomerulonephritis (GN) with
heavy proteinuria. Experimental data suggest that GAG could be used in
the treatment of GN for their antiproteinuric and antiproliferative effects.
The aim of this study was to assess the evolution of proteinuria during
the therapy with a natural GAG (Sulodexide), which comprises a heparin-like
substance and dermatan-sulphate. The study was carried out in 20 patients
with different types of GN (males-12; females-8; mean age- 38.95?12.49
y). 18 p underwent kidney biopsy processed in light microscopy. In 9 p
histochemical stainings were performed (toluidine blue, Alcian blue) in
order to reveal GAG deposits and immunohistochemical stainings (Cytokeratin,
Desmin, Vimentin, PCNA, Actin) to evaluate interstitial involvement in
renal fibrosis. Sulodexide was administered i.v., 1 ampoule daily, for
30 days. The following parameters were assessed at the beginning and at
the end of the therapy: hemoglobin, leucocytes, fibrinogen, thrombocytes,
prothrombin index, BUN, serum creatinine, creatinine clearance, hematuria.
Proteinuria was evaluated initially and on day 8, 16, 30 of therapy and
after 10 days from the discontinuation of therapy. The short-course i.v.,
therapy with Sulodexide reduced proteinuria in 85% of the patients. The
initial mean value of proteinuria in these patients decreased significantly
at the end of the therapy (p<0.01). Proteinuria decreased in all patients
with mesangio-capillary (MCGN), whereas the therapeutic result was far
more modest in patients with membranous- and mesangio-proliferative GN.
The decline of proteinuria is more relevant in GAG(+) patients, with important
proximal tubular necrosis and moderate to severe myofibroblast infiltrates
in comparison with GAG(-) patients, with mild interstitial involvement.
The therapy had no significant side effects. The short-course therapy with
Sulodexide decreases significantly proteinuria in patients with MCGN and
in p with interstitial GAG deposits, without any significant side effects.
Key words: Glomerulonephritis, proteinuria, glycosaminoglycans,
interstitial fibrosis, Sulodexide, renal function
UTICAJ TERAPIJE PRIRODNIM GLIKOZAMINOGLIKANIMA
(SULODEKSID)
NA PROTEINURIJU U RAZLIČITIM OBLICIMA GLOMERULONEFRITISA
Kratak sadržaj: U glomerulonefritisu sa masivnom proteinurijom nađene
su promene glikozaminoglikana (GAG) glomerulske bazalne membrane. Eksperimentalni
nalazi sugerišu da se antiproteinurički i antiproliferativni efekti GAG
mogu koristiti u terapiji. Cilj ovog ispitivanja bio je da se ispita kretanje
proteinurije u toku terapije sa GAG (Sulodeksid), koji sadrže heparinu-slične
substance i dermatan sulfat. Kratkotrajna i.v. terapija Sulodeksidom dovela
je do smanjenja proteinurije u 85% bolesnika. Na kraju lečenja došlo je
do statistički značajnog smanjenja proteinurije (p<0,01). Smanjenje
proteinurije nađeno je u svih bolesnika sa MCCG, dok je rezultat bio skroman
u bolesnika sa membranoznim i mezangioproliferativnim GN. Sniženje proteinurije
bilo je izraženije u GAG(+) bolesnika. Nije bilo značajnih nuzgrednih efekata
terapije.
U zaključku, kratkotrajna terapija sa Sulodeksidom dovela je do značajnog
sniženja proteinurije u bolesnika sa MCGN i bolesnika sa depozitima GAG.
Ključne reči: Glomerulonefritis, proteinurija, glikozaminoglikani,
intersticijska fibroza, Sulodeksid, bubrežna funkcija
