الفهرس 
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Abstract
Diabetic nephropathy is the leading cause of kidney failure all over the world. Vascular endothelial dysfunction (VED) is thought to play a key role in stemming the epidemic of diabetic nephropathy and cardiovascular disease. Mechanisms that participate in the reduced vasodilatory responses in endothelial dysfunction include reduced nitric oxide generation and oxidative stress. Asymmetric dimethylarginine (ADMA) is an endogenous inhibitor of endothelial nitric oxide (NO) synthase .ADMA result in impaired production of nitric oxide (NO) and hence progression of VED.
The goals of this study is to evaluate new prognostic markers for detection of nephropathy in diabetic patients receiving either conservative treatment, regular hemodialysis or even undergo kidney transplantation. In the mean time, to assess any correlation between vascular endothelial dysfunction, the oxidative stress and the progression of diabetic nephropathy.
This study included 15 non-dialyzed DN patients, 15-hemodialysed patients (divided into pre- & post-HD) and 10 kidney transplanted patients together with 10 healthy control subjects.
Blood samples were drown after overnight fasting in all subjects; additional blood samples were drown from hemodialyzed patients at the end of hemodialysis session. All subjects subjected to thorough clinical examination and laboratory investigations including: serum urea, creatinine, fasting and postprandial blood glucose, HbA1c, lipid profile and serum 8-isoprostane, pl. GSHpx, ADMA and nitric oxide level.
The results of the present study were clearly indicated that:
-Levels of ADMA and 8-isoprostane to be higher in the hemodialyzed patients, as well as DN patients than in the control group, although they improved following kidney transplantation.
-In the mean time, results showed levels of nitric oxide and pl.GSHpx to be lower in HD-, as well as DN group than in the control group, although they improved following kidney transplantation.
-ADMA and 8-isoprostane can be used as markers of progression of kidney disease among diabetic patients.
-A highly significant positive correlation was shown between 8-isoprostane and FBS also between ADMA & creatinine. In the mean time, a highly significant negative correlation was shown between ADMA & nitric oxide, between nitric oxide & HbA1c and between nitric oxide & creatinine in group I.
-A highly significant positive correlation was shown between 8-isoprostane and HbA1c, ADMA & creatinine and 8-isoprostane & HbA1c. In the mean time, a highly significant negative correlation was shown between ADMA and nitric oxide in group II.
-A highly significant negative correlation was shown between ADMA & nitric oxide in group III.
-A highly significant positive correlation was shown between 8-isoprostane & HbA1c in group IV.
Based On These Findings, It Is Concluded That:
Decreased nitric oxide, increased oxidative stress, and increased ADMA contribute to diabetic nephropathy progression.
Targeting on increasing nitric oxide, reducing oxidative stress, and lowering ADMA levels to may be specific therapeutic interventions to prevent diabetic nephropathy progression.