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Published ahead of print on February 11, 2009
Clin J Am Soc Nephrol 4: 535-541, 2009
© 2009 American Society of Nephrology
doi: 10.2215/CJN.04330808
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Chronic Kidney Disease

Effect of Renin Angiotensin System Blockade on Pentraxin 3 Levels in Type-2 Diabetic Patients With Proteinuria

Mahmut Ilker Yilmaz*, Jonas Axelsson{dagger}, Alper Sonmez{ddagger}, Juan Jesus Carrero{dagger}, Mutlu Saglam§, Tayfun Eyileten*, Kayser Caglar*, Alper Kirkpantur*, Turgay Celik*, Yusuf Oguz*, Abdulgaffar Vural*, Mujdat Yenicesu*, Bengt Lindholm{dagger}, and Peter Stenvinkel{dagger}

* Department of Nephrology, {ddagger} Department of Internal Medicine, and§ Department of Radiology, Gülhane School of Medicine, Etlik-Ankara, Turkey; {dagger} Divisions of Renal Medicine and Baxter Novum, Department of Clinical Science, Intervention and Technology, Karolinska Institutet, Stockholm, Sweden

Correspondence: Dr. Mahmut Ilker Yilmaz, Department of Nephrology, Gulhane School of Medicine, 06018 Etlik-Ankara, Turkey. Phone: +90 312 3044076; Fax: +90 312 3042920; E-mail: mahmutiyilmaz{at}yahoo.com

Background and objectives: Long pentraxin 3 (PTX3) is a multimeric inflammatory mediator. Increased serum PTX3 levels have been reported among end-stage renal disease patients. Moreover, PTX3 has been suggested to represent a novel mortality risk factor, and elevated PTX3 levels have been shown to accompany increased albuminuria among patients with chronic kidney disease (CKD).

Design, setting, participants, & measurements: We analyzed data of 49 persons with stage 1 diabetic CKD and 32 healthy subjects in a prospective controlled trial. Endothelial dysfunction was determined by flow-mediated dilation (FMD). Serum PTX3, high-sensitivity C-reactive protein (hs-CRP) levels, and FMD were studied in baseline and after 12 wk of ramipril therapy. Stepwise multivariate regression analysis evaluated the association of FMD with clinical and serologic parameters.

Results: Serum PTX3, hsCRP, and albumin levels and proteinuria were significantly decreased, and FMD levels were significantly increased, after ramipril treatment. FMD was negatively correlated with serum PTX3, 24-h proteinuria, and hsCRP levels and positively correlated to serum albumin both at baseline and after the 12-wk treatment period. Multivariate regression analysis revealed that PTX3 levels were independently related to FMD both before and after ramipril treatment.

Conclusions: Our study shows that serum PTX3 levels are associated with endothelial dysfunction in patients with stage 1 diabetic CKD, independent of CRP. In addition, short-term ACE-inhibitor treatment significantly improves FMD and normalizes PTX3, hsCRP, and urinary protein excretion. (NCT: The study was registered in clinicaltrials.gov as NCT00674596.)






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