UA25961U - Method for treating diabetic nephropathy - Google Patents

Abstract

A method for treating diabetic nephropathy comprises the use of insulin, balanced alimentation, ACE inhibitor, blocker of angiotensine II receptors and antiaggregant or anticoagulant. In addition, espa-lipon, a preparation of tioctic acid is prescribed at a dose of 600 mg in 200 mL of isotonic solution of sodium chloride intravenously dropwise daily for 20 days.

Description

Description of the invention

A useful model relates to medicine, namely to internal diseases, and can be used in 2 treatment of diabetic nephropathy.

The most common endocrine disease in Ukraine is diabetes mellitus (DM). The formation of micro- and macroangiopathies in patients with diabetes occurs in parallel with the development of late complications.

Diabetic nephropathy (DN) is the greatest threat to the life of patients with diabetes. Every second is sick with

Type 1 diabetes and every 4-5 patients with type 2 diabetes die from chronic kidney failure. DN is one of the 70 most serious complications of diabetes, the presence of which sharply reduces the quality and life expectancy of patients. DN is a complex of various pathomorphological changes of the vascular-glomerular-tubular apparatus of the kidneys. The pathogenesis of DN is determined by the action of numerous factors - genetic, metabolic, immunological and hemodynamic.

Complex therapy aimed at restoring metabolic processes in the body of patients, correcting intraglomerular hemodynamics, normalizing lipid metabolism against the background of glycemic control prevents 12 or slows down the progression of DN.

Currently, a sufficient arsenal of agents is known that act on the main links of the pathogenesis of DN.

So, for example, in the study of Neagi Rgoiesiop Bischau, 40 mg of simvastatin reduced the severity of the main vascular events and ensured a decrease in SER (diotetiag TKgayop gae, the degree of glomerular filtration)) in patients with diabetes mellitus, regardless of the level of cholesterol in basal conditions by 2590 |SoiPpe K., Agtiade - ., Ragizp 5.,

Zividpy R., Re Kk. ISS/VNE Neaigi Rgoiesiop Bitsau oi spoiIeviegoI-Iomegipud m/y reportmaviayp ip 5963 reorie m/p adiarefez: a hapdotivzei riasero-sopigoPey iga! // Hapseiy - 2003. - M. 361. - R. 2005-2016). In addition, the recently presented results of the SACOZ study (SoParogaime Aiyuguaviaip Oiaresez Bischau) found a reduction in cardiovascular events in patients with DM who had at least one additional risk factor for coronary artery damage if they took statins, which is recommended for all DM patients. 29 The use of antioxidants as an intervention to reduce diabetic nephropathy is of interest. -at

Clinical studies show that the use of antioxidants helps in preventing or alleviating the severity of diabetic nephropathy.

She epPesi oi sotbBipei igeaytepi m/yy myatipy S apa E op aiYiritipygia ip iure 2 aiiareis rayepiv // Oiabrei

May - 2001. - M. 18. - R. 756-760; Wigwey! 5.E., SiIegptopi A.S., Aieyo |.R. her a). Nidp-dose myatip E - zirrietepiayop pogtaiyigevs gaypa! riooi4 Him apa sgeaypipe sieagapse ip raiyepiv m/yp i(ure 1 aiareev / «o

Oiabeiyez Sage. - 1999, - M. 22. - R. 1245-12511.

The antioxidant effects of vitamins C and E have been confirmed: a significant reduction in the plasma level of malondialdehyde (MDA) was found in the groups of patients with diabetes who received these drugs (|Naiiyimei! V., Spigiso 5. (yuyu

Mriy regohidayop: iv tespapizt, teazigetepi apa vidpiysapse / At U Siip My. - 1993. - M. 57 (Zirri. v5), - R. 715-725). high school

The effectiveness of the use of vitamins C and E and the combination of vitamins C and E with magnesium and zinc admixtures has been proven to improve the function of renal glomeruli, but not renal tubules, in patients with T2DM |M.5. Ragmid, M.

Uaiaiyi, R. Ziavzvi, M. Novzveipi Sotragizop oi (She EPesiv oi Misatipv apa/og Mipega! ZiGrrietepiaiop op «

Siotegshag apa Tibshag Suziipsiop ip Toure 2 Oiabeyez // Oiare (ez Sage. - 2005. - M. 28. - R. 2458-2464). With 50, the results of the KEMAAG study (Keaisiyop ip Eparoipiv ip Mop-ipzciip derepaepi aiabefez teyiiv m yp ySHte s Apdiogepvip II Apiadopivzi I ozapap) proved the positive effect of losartan. The study was carried out in 250 centers in

From" 28 countries involving 1,513 patients. Every 5095th reduction in albuminuria reduces the risk of cardiovascular endpoints by 1895. Te Gozagpap Kepai! Rgoiesiop Zischau: gayopaie, vzischau devzidp apa brazeiipe spagasiegiziisv oi KEMAAI (Kedisiop oi Eparoipiv ip MIOOM m/y (pe

Apdiogepvip II Apiadopivi I ozagiap) // ) Kepip Apdiogepvip AIdoviegope Buzi. - 2000. - M. 1. - R. 328-335). o Various therapeutic strategies can reduce albuminuria, including hypoproteinuria, methindole, 4! antihypertensive drugs of the ACEIV5 and AIIAv type. Because the dose-response curves for blood pressure (BP) and albuminuria are different, it is possible that therapy aimed at reducing albuminuria may result in an additional positive effect in the form of BP reduction | ameptap 0.0., Neppipda K.N., Yuoe dopo R.E. her a).

Gee! 20 Oriita! apiirgoivipygis dove oi Iozayap ip pop-diabeiis rayepiv m/yip perpgoiis hapde rgoieipygia / At / щ Kidpeu Oiv. - 2001. - M. 38. - R. 1381-1384; Apdegzep 5., Kovzvipd R., U!tsyI T.M. oh oh Oriita! dove oi "7 Iozapap og heporgoiesiop ip diareyis perpgoraiiu // Merngoi! Oia! Tgaperi. - 2002. - M. 17. - R. 1413-1418).

Acetylcysteine can also have a renoprotective effect (Terei M., map deg sSiei M., Zspulagleii S. ei ai.

Rhemepip oyi gadiodharpis-sopigavi-adepi-ipdysey hedysiope ip sgepa! iopsiop bu aseiyuYisuvivipe / M Epoi in 22 Med. - 2000. - M. 343. - R. 180-184). c Pharmacological blockade of the renin-angiotensin system effectively delays the progression of kidney damage in patients with diabetes mellitus with diabetic nephropathy |Vgeppeg V.M., Sooreg M.E.

Ipmezviidayoge: EPesiv oi Iozapyap op hepa! ap sagaiiomazsciag otsisotev ip rayepiv m/yyp yure 2 aiare(ez apa perpgoraiyu // M Epo! In May. - 2001. - M. 345. - R. 861-869; Ragmipd N.N., Genpei N., Vgospeg- Mogiepzep .. 60 ge ai., "(pe Igrezagap ip Raiyepiv MUyp Ture 2 Oiarefgez apa MisgoaIritipygia 5ishau OSgotsr: Te eyPesi oi igrezagpap op (She demyurtepi oi aiareis perpgoraiytu ip raiepiz m/yy iuure 2 aiarefsez // M EEpoI! In Med. - 2001. - M. 345. - P. 870-878), which connects ACEvs with ACE receptors and can be a mediator of the effect of free radicals on the mesangial cells of the kidneys in diabetic nephropathy. The results are compatible with the idea that the renin system of angiotensin is of critical importance in the pathogenesis of diabetic nephropathy (Adieg 5. bo riareis perpgoraipu: IpkKipud pivioidodu, sei! Bbioiodu, apa depeiisz // Kiapeu Ipi. - 2004. - M. 66. - R. 2095-2106).

Antihypertensive therapy can stop the progression of renovascular diseases and contribute to the preservation of renal function |Viospy M.), RisKegipu T. Kepa! mazsciag disease: teidisai tapadetepi, apdioriaziu, apa viepiipud // Zetip Merngo)!. - 2000. - M. 20. - R. 474-488).

The use of perindopril for three years in normotensive patients with diabetes mellitus-1 with normoalbuminuria delayed the increase in albuminuria (Kme(pu 9U., Sgedegzep O., Redegzep K.5. iure 1 aiareifevs pteiiiyiv // 0) May 90 - 2001. -

M. 94. - R. 89-94), In patients with T2DM, both ACE inhibitors and AKV5B reduce the risk of diabetic nephropathy and reduce the frequency of cardiovascular events. 70 In the MISKO-NORE study (Neag Ochisotevs Rhemepiop EmaiYitsayop) ramipril (1Omg/day) reduced the risk of severe nephropathy by 2495 during 1 year of use (Neai Ocysotez Rhemepip | maIsayop Zitsau

Ipmezviidayoge: EPesiv oi gathirgi op sagaiomazstsag apa tisgomazstiag otsisotevz ip reorie m/yip aiare(ev teiYShiv: geziiiv oi pe NORE zishau apa MISKO-NORE zybrzitsau // I apsei. - 2000. - M. 355. - R. 253-259) .

Rosiglitazone has a beneficial effect in preventing renal complications in patients with T2DM |VakKgiz ., Miregii 7/5 Z. MMeviop MU.M. her a). Kozidiyalope geitssez igipagu aritip ehsgeyop ip yure PP aiiarefez // y) Nit

Nuregiepz - 2003. - M. 17. - R. 7-12).

Repaglinide (Nazviaspeg S. bZaieyu apa eyisasu oi heradiipide ip іure 2 aiiabeiiys rayepiv m/yy apa Ulpotsi itraiigei hepa! Topsiop // OiarebFevs Sage. - 2003. - M. 26. - R. 886-891) and nateglinide (Oye!I Rgao 5., Neipe

K.3., Kaywop 1. ей аЙ. Tgeaitepi oi raiepiv omega 64 ueagz oi ade m/yy iuure 2 aiiabreifev: ehregiepse Pot 2o paiiediipide rooiei daiyaraze gekgozresiime apaiuziv // Oiareges Sage. - 2003. - M. 26. 0 R. 2075-2080) have a short duration of action, are excreted by non-renal mechanisms, and therefore are safe for patients with renal failure.

Low-dose aspirin: recommended for primary and secondary prevention of cardiovascular events in adults with diabetes. This therapy does not have a negative effect on kidney function in patients with TDM-1 and TDM-2 with micro- or macroalbuminuria dose aseiuiizaiisuiiis asii op Kidpeu Tpsiop ip iiure 2 aiareiis raiyepiz m/yip eiemayeey ysgipagu airytip ehsgeyop hafe // Merpgo! Oiai t

Tgapegriapi. - 2003. - M. 18. - R. 539-542).

Glycosaminoglycan Sulodexin significantly reduced albuminuria in patients with TDM-I and TDM-2 with micro- or macroalbuminuria (| FUre 7 apa i(Ure 2 aiareis rayepiv: She 0i.MA.A.5. hapdotigei (a! //

In At Bos Merpgo). - 2002. - M. 13. - R. 1615-1625). X,

Pimazhedin, a secondary derivative of the inhibitor of common glycosylation, reduces the excretion of protein in the urine and Ge! reduction of ESA in patients with T1DM with proteinuria in a randomized, placebo-controlled trial

IVoyop MUK. Satsgap O.S., Mushiate M.E. her a). Kapdotigei ia oi ap ippiryog oi Togtaiop oi aimapsei Shcheo, diusayop epa rgodisiv ip diareyis perpgoraiyu // At U) Merngoi. - 2004. - M. 24. - R. 32-40). with

Intensive insulin therapy using semi-synthetic insulins, a balanced diet with a count of bread units, ACE antagonists, angiotensin II receptor blockers, antiplatelet agents and anticoagulants - a generally accepted therapeutic complex aimed at correcting kidney function and glycemic control |Dedov I.I., Shestakova M.V. Diabetic nephropathy. - M., 2000. - 225 pp in patients with "

CD with DN. - c This method of treating DN is the closest to what is claimed in terms of technical essence and the result that can be achieved, therefore it was chosen as a prototype. with The main drawback of the known methods of treatment is insufficient renoprotective and antioxidant effects, insufficient lipotropic effect, and most importantly - lack of neurotropic effect, which significantly reduces the effectiveness

Commonly accepted therapeutic complexes and increases the risk of progression of DN. In connection with the above, the basis of a useful model is the task of increasing the effectiveness of the treatment of diabetic nephropathy by preventing its further development. o The problem, which is the basis of a useful model, is solved by the fact that there is a known method of treatment

Ge) of diabetic nephropathy, which includes the appointment of insulin, a balanced diet, an ACE inhibitor, an angiotensin I receptor blocker, and an antiplatelet agent or anticoagulant, according to a useful model

Me, additionally prescribe the preparation of thioctic acid espa-lipon at bO0Omg per 200 ml of an isotonic solution of chloride as sodium intravenously daily for 20 days.

The technical effect of the useful model, namely the increase in the effectiveness of the treatment of DN, is due to the additional introduction of espa-lipone into the therapeutic complex

Espa-lipone, or thioctic acid (TC) (1,2-dithiolane-3-valeric acid), is a coenzyme that is part of the cocarboxylase group of enzymes involved in the regulation of carbohydrate and fat metabolism. TK is of great importance in the processes of energy generation in the body because it is a cofactor in the oxidative decarboxylation of alpha-keto acids (pyruvic, alpha-ketoglutaric and branched alpha-keto acids), which occurs in the matrix of mitochondria. TC activates pyruvate dehydrogenase and inhibits pyruvate carboxylase. TC contributes to elimination of metabolic acidosis.

TK has a positive lipotropic effect, accelerates the oxidation of fatty acids. TC facilitates the transfer of acetate and fatty acids from the cytosol to the mitochondrial matrix for further oxidation, increases the formation of coenzyme c).

TK is a highly active antioxidant: it promotes the functioning of the aglutathione and ubiquinone system.

The antioxidant effect of TC is due to the presence of two thiol groups in its molecule and the ability to bind b5 Radical molecules and free tissue iron, preventing its participation in LPO. TK not only has its own antioxidant potential, but also supports the work of other antioxidant systems in the body,

especially the glutathione and ubiquinone systems. The antioxidant potential of TK contributes to more effective repair of DNA molecules after damage due to "oxidative stress. TK contributes to the restoration of sensitivity of insulin receptors.

TK is a neurotropic drug, has a positive effect on the state of the autonomic nervous system, promotes the increase of glucose uptake by peripheral nerves, which improves their function. Treatment of TC in a dose of bOOmg 2 times a day for 4 weeks in patients with type 2 diabetes with normal or increased body weight causes a significant decrease in the level of lactic acid and gray matter after a glucose load due to an increase in the efficiency of glucose assimilation. 70 The method is performed as follows:

The generally accepted therapeutic complex, aimed at the correction of kidney function and glycemic control in patients with diabetes mellitus with DN, includes intensive insulin therapy using semi-synthetic insulins, a balanced diet with a count of bread units, ACE inhibitors (lisinopril (diroton) 5, 10, 15 mg per day) , angiotensin I receptor blockers (lasartan, irbesartan, valsartan - 80-160 mg per day), /5 antiplatelet agents (aspirin, dipyridamole) or anticoagulants (warfarin).

In this therapeutic complex, the preparation of thioctic acid espa-lipon is additionally prescribed by bo0Omg per 200 ml of isotonic sodium chloride solution intravenously every day for 20 days.

The effectiveness of the method is illustrated by the following examples:

Example 1. Patient D-ko, 56 years old, was admitted to the endocrinology department with complaints of general malaise, periodic dry mouth, polyuria, episodes of hypoglycemia alternating with episodes of ketoacidosis, visual impairment, headache, sleep disturbance.

He has been suffering from diabetes for 26 years. Objectively: general condition - satisfactory, body mass index (BMI) - 31 kg/m? (16o0cm, 78kg), OT / OS - 1.08. The skin is pale, pink, clean. Normosthenic physique. Auscultation in the lungs - vesicular breathing. Heart sounds are muffled, activity is rhythmic, heart rate (HR) - 84 bpm, blood pressure - 160/100 mm Hg. Art. The tongue is moist, clean, with a white coating near the root. The abdomen is soft, the liver is on the edge of the hypochondrium. Pasternacki's symptom is negative.

Carbohydrate metabolism: fasting glucose (FAG) - 15.7 mmol/l; postprandial glucose (GKP) - 16.2mMmMol/L; che 3o amplitude of glucose oscillations (HKA) - b, Zmmol/l; glycosylated hemoglobin (NNAiYs) - 14.995, insulin - 4.93MKOD/ml. uh-oh

Functional kidney tests: glomerular filtration rate (GFR) - 105.bml/h, creatinine - 119.b6μmol/l, urea - 8.8mmol/l, urinary microalbumin excretion (EMA) - 300.5mg/day, C - reactive protein (SRP) - 6b, 58mg/ml. at

Indicators of protein, enzyme metabolism and blood coagulation system: total protein - 60.Zg/l; with albumin - 50,395; globulins: a 8.8595, pz - 9.5290, c -11.095, y - 20.695; aspartate aminotransferase (AST) - 0.59 mmol/l; alanine aminotransferase (ALT) - 0.b1mmol/l; prothrombin index (PTI) - 95,690; fibrinogen - 6.5 g/l; fibronectin - 433.Omkg/ml; homocysteine - 19.7 μmol/l. "

Indicators of lipid metabolism, the state of lipid peroxidation (LPO) and the system of antioxidant protection pt") with (AOZ): total cholesterol (Z3ХС) - 6.62 mmol/l, triglycerides (TG) - 2.82 mmol/l, lipoprotein cholesterol. high-density lipoprotein (HDL-C) - 1.03 mmol/l, low-density lipoprotein cholesterol (LDL-C) - and? 4.25 mmol/l, very low-density lipoprotein cholesterol (VLDL) - 1.3 mmol/l, higher fatty acids (FA) - 372.Ommol/l, atherogenicity coefficient (CA) - 6.5 U, Pv type of hyperlipidemia (HLIP ); MDA in blood serum - 2.95μmol/l, MDA in erythrocytes - 13.8μmol/l, peroxidase - 387.0μmol/l, catalase - 36b, 8mg, coceruloplasmin - b, 4μmol/l.

Indicators of bioelement exchange: potassium - 3.2 mmol/l, sodium - 165.00 mmol/l, calcium - 1.3 mmol/l, phosphorus 1 - 1.7 mmol/l.

Ge) Diagnosis: diabetes mellitus type 1, severe, stage of subcompensation, diabetic nephropathy of the 3rd degree, 5 years arterial hypertension of the 2nd degree, retinopathy of the 1st degree, polyneuropathy, obesity of the 2nd stage.

Me, the patient was treated according to the scheme: medical nutrition - table Me9, insulin therapy - 52 units per day, diroton - 5 mg per day, espa-lipon - bbOmg intravenous drip.

After the treatment, the patient's condition improved, all subjective manifestations disappeared.

Objectively: the general condition is satisfactory, BMI - Zikg/m2, OT / OS - 0.97, BP - 130/8O0MM of mercury. st., pulse - 80 beats/min.

Indicators of carbohydrate metabolism and the functional state of the kidneys: GKN - 8.9 mmol/l, HCP - 10.7 mmol/l, HKA - 4. mmol/l, NAIiYs - 8.895; insulin - b, 4μOD/ml; creatinine - 100.bmmol/l, urea - 7.1 mmol/l, GFR - 116.2 ml/min., EMA - 88.2 mg/day, SRP - 3.4 mg/ml.

Indicators of protein, enzyme metabolism, blood coagulation status: total protein - 65.8g/l, albumins - 55.095, globulins: a. - 7.696, az - 9.595, B - 11.4965, y - 16.595, AST - 048mmol/l, ALT - 0.51mmol/l, PTI - sh 90.0905, fibrinogen - 4.Zg/l, fibronectin - 350, Omkg/ml, homocysteine - 9.5μmol/l.

The state of lipid metabolism and POL and AOZ: ZCHS - 5, vmmol/l, TG - 2.1mmol/l, HDL-C - 1.2mmol/l, LDL-C -

Z.7mmol/l, CH LOIODNSH - O0.92mmol/l, VJK - 240.Ommol/l, KA - 4.8 UNITS.

MDA in blood serum - 1.35μmol/l, MDA in erythrocytes - 9./μmol/l, peroxidase - 244, Ommol/l, 65 catalase - 14.7mg, ceruloplasmin - 1.3bμmol/l.

Indicators of bioelement exchange: potassium - 4.4 mmol/l, sodium - 146.00 mmol/l, calcium - 1.55 mmol/l, phosphorus

- 1.3 vmmol/l.

As a result of the therapy, the indicators of carbohydrate and lipid metabolism were improved, the indicators of protein, enzyme, bioelement metabolism, the state of POL and AOZ, the blood coagulation system, and homocysteine indicators were restored.

Complex therapy with the use of an ACE inhibitor, diroton and espa-lipon caused a positive therapeutic effect, which was manifested by an improvement in general well-being, normalization of blood pressure, metabolic processes and the functional state of the kidneys.

Example 2. Patient P-a, 59 years old, was admitted to the endocrinology department with complaints of general malaise, dry mouth, increased thirst, polyuria, episodes of hypoglycemia and ketoacidosis, headache, decreased memory, palpitations, cardiac pain, shortness of breath , pain in the lumbar region.

He has been suffering from diabetes for 8 years. He considers stress to be the cause of the disease, he was on insulin therapy, he did not monitor carbohydrate metabolism regularly, his blood sugar level was 12.5 mmol/l.

Objectively: general condition - satisfactory, BMI - 27 kg/m? (168cm, 7/Zkg), OT / OS - 32.8. Integuments - 75 pale pink, clean. Hypersthenic type. Auscultation in the lungs - vesicular breathing. Heart sounds are muffled, activity is rhythmic. Blood pressure - 170/9 Ohm Hg. art., heart rate - 98 beats/min. The tongue is moist, clean. The abdomen is soft, the liver is on the edge of the hypochondrium. Pasternacki's symptom is negative.

Carbohydrate metabolism: GKN - 12.7 mmol/l, GKP - 14.bmmol/l, HKA - 54 mmol/l, NbBAIs - 8.895.

Functional kidney tests: GFR - 107ml/min, creatinine - 117.4μmol/l, urea - 4.0mmol/l, EMA - 295.Omg/day, SRP - 6b.vmg/ml.

Indicators of protein, enzyme metabolism and blood coagulation system: total protein - 58.5g/l; albumin - 48,495, "y-globulin - 21,0965, AST - 0.bimmol/l, ALT - 0.69mmol/l; PTI - 87,995, fibrinogen - 5.4Ag/l, fibronectin - 48.5mcg/ml, homocysteine - 19.2 μmol/l.

Indicators of lipid metabolism, the state of POL and AOZ: ZHC - 6.2 mmol/l, TG - 2.7 mmol/l, HDL cholesterol - 1.05 mmol/l,

Chxs LYNSH - 4.Zmmol/l, CHS LIDNSH - 1.4mmol/l, VZHK - 378.0 μmol/l, KA - 6.6U, Pv type of HLP; MDA in blood serum - 3.04 µmol/l, MDA in erythrocytes - 16.5 µmol/l, peroxidase - 436 µmol/l, catalase - 39 µmol/l, ceruloplasmin - 7 µmol/l.

Indicators of bioelement exchange: potassium - 4.4 mmol/l, sodium - 140 mmol/l, calcium - 1.5 mmol/l, phosphorus - 1.vmmol/l. -

Diagnosis: type 2 diabetes, severe, subcompensated, secondary insulin-dependent, diabetic nephropathy grade C, arterial hypertension grade 2, retinopathy grade 1, polyneuropathy, encephalopathy.

The patient was treated according to the scheme: medical nutrition - table Me9, insulin therapy - 52 units per day, Me diroton - 5 mg per day, espa-lipon - bbOmg intravenous drip. yu

After the treatment, the patient's condition improved, subjective manifestations disappeared.

Objectively: the general condition is satisfactory, BMI - 27 kg/m2, OT / OS - 26.6, BP - 140/90 mmHg. art., heart rate - 80 beats/min. with

Indicators of carbohydrate metabolism and functional state of the kidneys: GKN - 8.7 mmol/l, HCP - 9.bmmol/l, HKA - 4.mmol/l, HrAIСs - 7.790.

Creatinine - 9 µmol/l, urea - 4.0 mmol/l, GFR - 9 Iml/min, EMA - 87.Omg/day, SRP - 33.2 mg/ml.

Indicators of protein, enzyme metabolism, croisian coagulation state: total protein - 63.7g/l, albumins - - 50 55.6905, t -globulins - 17.095, AST - 0.51mmol/l, ALT - 0.5immol/l, PT1 - 87,995, fibrinogen - 2.4g/l, - fibronectin - Zb5mcg/ml, homocysteine - 9.8μmol/l. and? The state of lipid metabolism and POL and AOZ: ZHC - 4 2mmol/l, TG - 1.69mmol/l, HDL cholesterol - 2.0mmol/l, HDL cholesterol -

C, 2mmol/l, CH LPDNSH - 0.94mmol/l, VJK - 246bmmol/l, KA - 4.7 UNITS.

MDA in blood serum - 1.64 μmol/l, MDA in erythrocytes - 9.2 μmol/l, peroxidase - 335 μmol/l, co catalase - 25.Omg, ceruloplasmin - 2.7 μmol/l.

Indicators of bioelement exchange: potassium - 4.4 mmol/l, sodium - 140 mmol/l, calcium - 1.6 mmol/l, phosphorus - 1 1.4 mmol/l.

Ge) As a result of the therapy, a positive therapeutic effect was obtained, which was expressed by an improvement of 5o General well-being, normalization of blood pressure. The improvement of carbohydrate and lipid metabolism, me) recovery of protein, enzyme, bioelement metabolism, the state of POL and AOZ, the blood coagulation system, as indicators of homocysteine have been established.

Complex therapy using a balanced diet (table Me9), insulin therapy, diroton in combination with espa-lipon in patients with type 2 diabetes has a positive therapeutic effect and prevents the progression of the development of DN.

The use of complex therapy in patients with diabetes with DN 1, 2, 3 degrees contributed to the normalization of carbohydrate metabolism, prevention of the development of microalbuminuria and arterial hypertension.

The use of the ACE inhibitor diroton caused a hypotensive effect, as well as a renoprotective effect.

The use of espa-lipon increased the renoprotective effect, caused a positive lipotropic effect, as well as an antioxidant effect, exerted a neurotropic effect - significantly reduced the severity of diabetic polyneuropathy.

The results of the clinical study allow us to conclude that the use of espa-lipon in complex therapy in patients with diabetes can prevent the further development of DN. for

Claims (1)

The formula of the invention The method of treatment of diabetic nephropathy, which includes the appointment of insulin, a balanced diet, an ACE inhibitor, an angiotensin II receptor blocker, and an antiplatelet agent or an anticoagulant, which is distinguished by the fact that the thioctic acid drug espa-lipon is additionally prescribed at 600 mg per 200 ml of isotonic sodium chloride solution intravenously daily for 20 days. Official bulletin "Industrial Property". Book 1 "Inventions, useful models, topographies of integrated microcircuits", 2007, M 13, 27.08.2007. State Department of Intellectual Property of the Ministry of Education and Science of Ukraine. - «- (Se) (o) iv) s - with . and? ime) 1 se) (o) - c 60 b5