Effects of Cyclosporin A, Mycophenolate Mofetile, Vitamin A, D, E and N-Acetyl Systein in Rats With Nephrotic Syndrome

Abstract

N ephrotic syndrome (NS) is a disease characterized by intense proteinuria, hypoalbuminemia, hyperlipidemia, and edema findings resulting from impaired protein permeability of glomeruli. Focal segmental glomerulosclerosis (FSGS), renal histology that is more common in patients with steroid-resistant nephrotic syndrome (SDNS), is a poor prognostic sign. The probability of response to the immunosuppressives used is low, and side effects are common. [1] Today, the use of complementary therapies is accepted in cas-es where there is no response to immunosuppressives. There is a need for new options that are effective and have no side effects in the treatment of NS. New immunosuppressives or new complementary therapies should be researched. [2] By using adriamycin on rats, an NS model with FSGS histology can be created. Adriamycin-induced NS pathogenesis includes apoptosis. Damage develops in the visceral epithelial cells of the glomeruli, resulting in severe proteinuria, glomerular sclerosis, and diffuse tubulointerstitial damage. [3,4] Objectives: Patients with steroid-resistant nephrotic syndrome have a high risk of developing chronic renal failure. Cyclosporine A used in treatment is nephrotoxic. Data on the efficacy of mycophenolate mofetil used in the treatment are insufficient. New treatment options should be explored. Our research aims to investigate the effectiveness of cyclosporine A, mycophenolate mofetil, vitamin A, D, E, N-acetyl cysteine and their combinations in rats with nephrotic syndrome. Methods: The research was conducted with 48 adult male rats of the Wistar-albino. To induce nephrotic syndrome, two doses of adriamycin were administered to all rats 20 days apart. Serum creatinine, albumin, cholesterol, triglyceride, total oxidant status, total antioxidant status, protein in urine, creatinine, and creatinine clearance were analyzed in rats. Glomerulosclerosis index, total injury score, interstitial fibrosis score, TGF-and osteopontin analyzes were performed within the scope of the histopathological evaluation. Results: At the end of the study, the lowest 24-hour urine protein was found in group B (cyclosporin A + vit ACE), and the highest 24-hour urine protein in group C (mycophenolate mofetil). The highest serum creatinine, triglyceride, and cholesterol and the lowest serum albumin levels are in group A (cyclosporine A). The lowest serum creatine, triglyceride, and cholesterol and the highest serum albumin levels are in group D (mycophenolate mofetil + vit ADE). Conclusion: It has been observed that vitamin ACE added to cyclosporine A treatment reduces cyclosporine A nephrotoxicity, and vitamin ACE added to mycophenolate mofetil contributes positively to renal histopathological findings.