Background: Diabetic nephropathy characterized by persistent albuminuria is the single leading cause of end-stage renal disease. Renin angiotensin system (RAS) is considered to be involved in most of the pathological processes that result in diabetic nephropathy. The progression of diabetic nephropathy can be retarded by ACE inhibitors (ACEIs) in patients with type 2 diabetes. The aim of our study was to find out the antiproteinuric and renoprotective effect of Ramipril, an angiotensin-converting enzyme (ACE) inhibitor, in diabetic nephropathy patients.

Materials and Methods: The study was conducted on 63 patients of diabetic nephropathy of type 2 diabetes mellitus aged between 31-64 years, selected from indoor ward and subsequently followed up as outdoor patients of medicine department of Narayan Medical College and Hospital, Sasaram, Bihar. Treatment with Ramipril (ACEI) was initiated after proper control of blood pressure and plasma glucose. Before treatment and after 2 months of continuous therapy with Ramipril, proteinuria and GFR estimation by creatinine clearance method were assessed.

Results: Ramipril treatment improved renal function. After proper control of blood pressure and glycemia, overall GFR improved from 52.26±9.12 to 60.26±13.76 which further improved to 70.26±15.38 ml/min after ACE-inhibitor therapy. Overall proteinuria which was 1898.53±1348.80 mg/24hr before control of BP and glycemia reduced to 1614.26±1163.37 mg/24 hr after control of BP and glycemia and further decreased followed ACE-inhibitor therapy to 1373.26±1289.16 mg/24hr.

Conclusions: It was observed that proper control of glycemia and BP may lead to substantial improvement in GFR as well as proteinuria in type 2 diabetic patients with diabetic nephropathy. ACE-inhibitor institution following proper control of BP and glycemia may further improve the GFR and reduce proteinuria.

Keywords: Angiotensin-converting enzyme inhibitors, diabetic nephropathy, type 2 diabetes mellitus

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Faiyaz Ahmad Ansari

Assistant Professor, Department of Medicine,

Indira Gandhi Institute of Medical Sciences, Patna, Bihar.

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