Pentoxifylline in Management of Proteinuria in Diabetic Nephropathy

K. Tripathi, Reader, Dept. of Medicine, Institute of Medical Sciences, Banaras Hindu University, Varanasi-221005 (India) Dear Sir, We read with interest the article entitled ‘Decreased albuminuria by Pravastatin in hyperlipaedemic diabetics’, in volume 59, No. 4,1991, of Nephron [1]. Recently, we completed a study entitled, ‘Effect of pentoxifylline in the management of proteinuria amongst diabetics’. The study was conducted on 20 patients showing clinical evidence of diabetic nephropathy in the form of overt proteinuria and evidence of diabetic nephropathy with or without compromised renal function. The majority of patients had maturity – onset diabetes (80%) and 20% were non-insulin dependent. Evidence of triopathy (neuropathy, retinopathy and nephropathy) was present amongst 25% of the cases. 50% had diabetes of less than 10 years’ duration where as 25% patients had diabetes of more than 15 years. Most of the patients in the hypertensive group were azotemic, with mean serum creatinine values of 2.6 ± 0.6 mg/dl, whereas, amongst the normotensive group, serum creatinine was normal. All patients had overt proteinuria of more than 1 g/24 h. Amongst the hypertensive group, proteinuria ranged between 2.25 and 900 g/day, whereas, in the normotensive group, it was between 1.05 and 5.10 g/day (fig. 1). After a follow-up of 3 consecutive months with pentoxifylline, 1,200 mg in divided doses/day, there was a significant reduction in mean proteinuria values (hypertensive group: 6.2 ± 2.4 to 3.8 ± 2.1 g/day; normotensive group: 2.9 ± 1.5 to 2.1 ± 1.6 g/day, p < 0.01) (fig. 1). The hypertensive group did not receive antihypertens-ive drugs, and those who developed hypertensive crisis were dropped from the study. There was a significant improvement in the mean glomerular filtration rate (hypertensive group: 40.0 ± 11.9 to 48.1 ± 12.9 ml/min; normotensive group: 74.0 ± 35.1 to 81.9 ± 25.0 ml/min; fig. 2) and also a reduction in blood urea and serum creatinine. The responses were more obvious amongst normotensives than amongst hypertensives.