The Curative Effect Of Sulodexide To Idiopathic Membranous Nephropathy

Backgroud and ObjectiveMembranous nephropathy(MN) is one common pathological type of adult nephrotic syndrome(NS). Of the total MN, idiopathic membranous nephropathy(IMN) accounts for about75%～80%, and by now the pathogenesis of IMN is still unknown; The remaining20%～25%of MN is the secondary membranous nephropathy, which often occurs secondary to some other diseases, such as infection, autoimmune diseases, neoplasm, and some medication. The natural course of MN has large difference, some of MN patients can relieve itself(about25-30%), however, some of them will eventually progress to end-stage kidney(ESRD). There is one report demonstrating that about40%of MN will develop into ESRD finally. Presently the therapy for MN is controversial, most scholars agree that MN patients should be given individualized treatments according to their different risk degree of prognosis and should avoid actively using of glucocorticoid and (or) immune inhibitors for patients with low risk, since it could generate serious adverse reactions. MN was divided into three types by Cattran on the basis of its progressivity:the low-risk MN patients have normal renal function and the quantitative proteinuria is less than4g/24h; the intermediate risk MN patients have normal or near normal renal function and the quantitative proteinuria is4-8g/24h; the high risk MN patients have abnormal or deteriorated renal function and the urine protein quantitative is greater than8g/24h. For medium and low risk patients, treatments except immunosuppressant can be only considered, whereas for high-risk patients, they should be given active application of immunosuppressive therapy.The angiotensin converting enzyme inhibitor(ACEI) and angiotensin receptor blocker(ARB) have been the routine drugs for low risk and intermediate risk MN patients. ACEI/ARB show dose-dependent effect for reducing urinary protein. However, the side effect should be noted since70%of MN patients have normal blood pressure, and some of them can not tolerate symptoms of low blood pressure caused by ACEI/ARB drugs.Sulodexide is a kind of natural glycosaminoglycans(GAGs), which contains low molecular weight heparin and dermatan sulfate, and the two main ingredients have different working mechanisms and provide synergistic effects for MN therapy. For the past few years, Sulodexide has showed significant effect for reducing urinary protein in the secondary membranous nephropathy caused by diabetic nephropathy(DN), meanwhile present researches indicate that the primary mechanism of Sulodexide to reduce proteinuria of DN due to the protection for sertoli cell and glomerular basement membrane(GBM). IMN is one of Sertoli cell disease, and hormone and immune inhibitor have poor curative effects for some patients. Meanwhile, most of the researches aim at the studies about curative effect of Sulodexide for diabetic nephropathy,metabolic syndrome kidney damage and Cardiovascular and cerebrovascular diseases currently, nevertheless there were few reports about Sulodexide for IMN. The present study is to analyse the effectiveness of Sulodexide for IMN patients with low and intermediate risk by means of observing clinical efficacy and adverse reactions when using Sulodexide alone and combined using telmisartan treatment.MethodsTotal one fifty patients with low-intermediate risk IMN, which have been confirmed by the kidney biopsy and excluded the secondary membranous nephropathy generated from DN, systemic lupus erythematosus-lupus nephritis, viral hepatit and so on, were randomly devided into three treatment groups:Sulodexide therapy group, Telmisartan therapy group and combination therapy group. All patients were followed up for6months, when24-hour urinary protein quantity, plasma albumin, liver function, renal function, blood lipid, blood pressure and untoward effect were monitored periodically.Results1.Urine protein and plasma albumin levels in all three groups of patients were obviously improved after treatment. Compared with before, the24hours urine protein quantitative level decreased by44.36%in Sulodexide therapy group, which had no statistically significant difference compared to48.74%in Telmisartan therapy group. Result were significantly decreased by72.24%in combination therapy group compared with the above two single drug treatment groups;2. Liver function, renal function, blood lipid and blood pressure were no significant change in all therapy groups(P>0.05);3. One patient showed mild liver damage after using Telmisartan, postural hypotension occurred in Telmisartan therapy group and combination therapy group and each one in each group.ConclusionsSulodexide can effectively reduce the urinary protein of low-intermediate risk IMN patients, which has the same effect as Telmisartan, and the medicinal effect of combination with Telmisartan was superior to that of single Sulodexide using. It is safe to apply Sulodexide as there are no obvious liver and kidney function damage, hemorrhage, hypotension and other side effects.