ESPE Abstracts

Background: Diabetic nephropathy is a major microvascular complication of diabetes. It affects 25–35% of diabetic patients diagnosed under the age of 30 years. It is the leading cause of premature death in young diabetic patients.

Objective and hypotheses: This study was primary designed to assess the short-term effect (6 months) of allopurinol treatment compared to angiotensin-converting enzyme inhibitor (ACEI) and placebo in type 1 diabetic patients (T1DM) with microalbuminuria.

Method: The study included 90 (46 males and 44 females) type 1 diabetic adolescents who were recruited from the regular attendants of the Pediatric Diabetes Clinic. Adolescents with T1DM, less than 18 years with diabetes mellitus more than 5 years, microalbuminuria positive, repeated twice monthly were included. Patients were divided into the following groups: Group A: Patients who received allopurinol (zyloric 100 mg tablet), Dose: 100 mg/day. Group B: Patients who received Angiotensin Converting Enzyme Inhibitors (ACEI) Capoten 25 mg tablet with a dose of: 1 mg/kg dose every 12 h. Group C: Patients who did not receive any medications for microalbuminuria and served as a control group. Investigations: HbA1C, CBC, Blood urea nitrogen (BUN), Serum uric acid, Serum total proteins and serum albumin and micro-albumin in urine all were measured. Patients were followed up at 2-4-6 month respectively by comparing the studied parameters.

Results: After 6 months of receiving treatment; the microalbuminuria level did not change significantly either in the allopurinol group or in control group (P=0.124, P=0.89). ACEI proved to be superior to both in improving microalbuminuria (P=0.000). Serum levels of uric acid were significantly lower in patients on allopurinol tablets (P=0.02) whereas other groups showed increase in its level (P=0.38, P=0.24 respectively). There were positive correlations between Hb1Ac (r=0.440, P=0.001), duration of diabetes (r=0.968, P<0.001), blood pressure (r=0.232, P=0.028) and microalbuminuria. A borderline correlation between uric acid and microalbuminuria was found (r=0.207, P=0.050) that emphasizing on the role of uric acid in pathogenesis of DN. No Side effects of the given medications were observed.

Conclusion: Low-dose allopurinol was not effective in reducing microalbuminuria after 6 months of drug administration. Combination strategy should thus be a more effective tool for obtaining optimal control in patients with diabetic nephropathy.