On the treatment of early diabetic nephropathy with Losartan

Objective To observe the effect of angiotensin Ⅱ 1 type receptor antagonists (AT 1Ra) Losartan on the early diabetic nephropathy with microalbuminuria. Methods 80 cases of type 2 diabetes mellitus (DM) 〔24h urine albumine excretion rate (UAER) 20～200 μg/min〕, with or without hypertension, were selected. The changes of mean arterial pressure (MAP), 24h UAER, HbA 1c , creatinine clearance (Ccr), uratic acid (UA) etc. were compared before and after administration of Losartan (50 mg/d) or Enalapril (20 mg/d) for 12 weeks without changing the previous management of DM. Results No change of above indices was observed in the control group. In the patients with normal blood pressure, 24h UAER decreased from 48(34～118) to 38(21～89)μg/min (P0.05) in Losartan group and from 52(32～122) to 41(23～90)μg/min (P0.05) in Enalapril group. In the patients with hypertension, 24h UAER decreased from 62(38～123) to 46(29～88)μg/min (P0.05) in Losartan group and from 68(39～130) to 50(28～96)μg/min (P0.05) in Enalapril group. These therapeutic effects were similar and not related to the change of blood pressure. Conclusion AT 1Ra Losartan can reduce the albuminuria of early diabetic nephropathy. The effect of renoprotection is not solely dependent on the lowering blood pressure levels, other mechanism may be involved.