الفهرس 
INTRODUCTIONOnly 14 pages are availabe for public view
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Abstract
One of the most important diabetic care measure is the prevention of the chronic complications and associated metabolic derangements that can lead to increased morbidity and mortality including diabetic nephropathy.
Microalbuminurea defined as persistent subclinical increase in albumin axcretion rate to 30-300 mg/day (20-200 J.!g/min) in the absence of urinary tract infection and cardiac failure is the first clinically detectable sign of diabetic nephropathy. It is a marker of early vascular damage in the micro - and macrocirculation, leading to cardiovascular and renal diseases respectively .it1 this stage it is possible to intervene and stop or delay the onset or ameliorate the cause of such complications .
The discovered role of angiotensin II in the pathogenesis of diabetic nephropathy suggestes angiotensin II receptor antagonists as a valuable intervension in this case with lower incidence of adverse effects than other currently available agents .
Also oxidative stress characterized by over production of reactive oxygen species and depletion of cellular antioxidative defense mechanisms is evidenced in diabetes leading to biological damage as one of the wisely proposed mechanisms involved in the pathogenesis of diabetic complications including diabetic nephropathy again suggesting antioxidant supplementation as a future adjuvent therapy for diabetic patients.
The main aim of this investigation was to compare the renoprotective effects of Angiotensin II antagonist (valsartan) to that of antioxidant mixture (vitamins A, C, E, selenium,and medicinal yeast) in the early stage of diabetic nephropathy characterized by microalbuminuria for 6 months in normotensive (:Sl 40/90 mmHg)
,microalbuminuric NIDDM patients in the ab,sence of any other renal, cardiac, hepatic, or systemic disease, or any other medications use than the standard oral hypoglycemic agent (Giibenclamide 5 mg b.i.d).
Both the valsartan (n=13), and the antioxidant (n=!3) treated groups were compared to each other and to two control groups ; the healthy control group (n= I 0) , and the diabetic control group (n=10) which receive only the standard oral hypoglycemic agent
The results obtained in this study , emphasis the presence of oxidative stress and the possible role of reactive oxygen species in the pathogenesis of diabetic nephropathy, explaining the positive effect of
antioxidants as compared with angiotensin II receptor antagonist
(valsartan) in enhancing the clinical picture of diabetic nephropathy.
Both drugs reduced microalbuminuria significantly, with a % change of 21.33 % and 15.41% for valsartan and antioxidant respectively, without a significant difference between them, compared to a significant increase in the diabetic control group. Antioxidant therapy significantly reduced oxidative stress (malondialdehyde (MDA) plasma concentration ,with a% change of21.23%) and augmented the depressed endogenous anti oxidative mechanisms (elevation of reduced glutathione (GSH) blood concentration , with a% change of 17.11 %) compared to non significant results of valsartan .
Additionally antioxidant therapy significantly reduced glycemic control parameters; FBS,and BBPS,with a % change of 12.72% and 19.58% respectively,and glycated hemoglobin (HBA 1 c %), with a% change of
19.58% ,compared to only a significat reduction of 1-IBAic with a% change of I 0.08% in valsartan group. Both drugs equally improved patients lipid profile (total cholesterol and triglycerides). Additionally antioxidant improved liver functions indicated by transaminases .