Pentoxifylline May Ameliorate Diabetic Renal Disease

Laurie Barclay, MD

August 18, 2003

Aug. 18, 2003 — Pentoxifylline (PTF) reduces proteinuria and urinary excretion of N-acetyl-beta glucosaminidase (NAG) in patients with type 2 diabetes, according to the results of a randomized trial published in the August issue of the American Journal of Kidney Diseases. This marker is elevated in type 2 diabetes and is associated with tubulointerstitial disease.

"PTF reduces urinary protein excretion in subjects with diabetes with both normal renal function and renal insufficiency," write Juan F. Navarro, MD, from Hospital Nuestra Señora de Candelaria in Tenerife, Spain, and colleagues. "Investigations in animal models of acute renal failure have reported that PTF may significantly improve urinary excretion of NAG and ameliorate the impairment in renal tubular function. Moreover, theoretical considerations suggest that PTF should be able to protect against and even ameliorate tubulointerstitial damage."

In this prospective study, 45 patients with type 2 diabetes mellitus had significantly greater proteinuria and urinary NAG excretion at baseline than did 15 healthy controls matched for age and sex.

After receiving PTF at 1,200 mg/day for four months, 30 patients had mean decreases in urinary protein excretion and NAG-creatinine ratios from 920 ± 522 mg/day and 14.3 ± 16.9 U/g to 803 ± 523 mg/day ( P < .001) and 10.5 ± 9.3 U/g ( P < .05), respectively. Proteinuria and urinary NAG excretion did not change in a control group of 15 patients. Regression analysis revealed that urinary NAG excretion was significantly associated with duration of diabetes mellitus (r = .61; P < .001) and with proteinuria (r = .51; P < .001).

"Urinary NAG excretion is elevated in patients with type 2 [diabetes mellitus] compared with healthy individuals and increases as nephropathy progresses," the authors write. "PTF administration is effective in reducing proteinuria and urinary NAG excretion in these patients. These findings suggest that PTF may have beneficial effects on tubulointerstitial damage in diabetic kidney disease."

Am J Kidney Dis. 2003;42:264-270

Reviewed by Gary D. Vogin, MD

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