G. Bartolozzi

La sindrome nefrosica
A un certo punto, nel trattamento della sindrome nefrosica steroido-resistente, compare la dizione "vitamina E" di cui però non si rinviene traccia nella ulteriore lettura dell'articolo sui "tre regimi terapeutici" ecc.
Mi intriga conoscerne il ruolo eventuale, se pure ne è contemplato. Grato per la risposta, con i miei più cordiali saluti,


Giorgio Amato
abbonato
mercoledì, 20 Gennaio 2010, ore 18:08

Re:
Gent. Dottor Amato,

sono andato a rileggere la pubblicazione sulla sindrome nefrosica alla quale lei allude e ho cercato il riferimento alla vitamina E. Delle due citazioni riportate, una mi sembra risponda bene alla sua domanda.
Le allego il riassunto, sufficientemente lungo, comunque lei può ricercare facilmente il lavoro originale completo.

La saluto cordialmente,

Giorgio Bartolozzi

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Pediatr Nephrol 1999;13:649-52

Vitamin E treatment of focal segmental glomerulosclerosis: results of an open-label study.
Tahzib M, Frank R, Gauthier B, Valderrama E, Trachtman H.

Division of Nephrology, Schneider Children's Hospital of Long Island Jewish Medical Center, Long Island Campus of the Albert Einstein College of Medicine, New Hyde Park, NY 11040, USA.

Experimental data indicate that excessive production of reactive oxygen molecules contributes to progressive renal injury and that treatment with antioxidants attenuates this damage. Therefore, we investigated whether vitamin E supplementation could ameliorate renal disease and reduce proteinuria in children with a variety of kidney disorders. Vitamin E, 200 IU twice daily, was administered orally to 11 children with focal segmental glomerulosclerosis (FSGS) (group A) and 9 patients with miscellaneous kidney diseases (group B) [Henoch-Schönlein purpura nephritis (n=3), urinary tract anomalies (n=2), non-specific immune complex glomerulonephritis (n=2), IgA nephropathy (n=1), and reflux nephropathy (n=1)]. The duration of vitamin E treatment, when no other therapy was introduced, was 2.9+/-0.4 months. Proteinuria was determined by measuring the protein:creatinine ratio (mg/mg) in an early morning urine specimen. In children with FSGS, administration of vitamin E lowered the protein:creatinine ratio in 10 of 11 patients from 9. 7+/-5.1 to 4.1+/-1.1 (P<0.005). In contrast, among children with miscellaneous renal diseases, vitamin E had no beneficial impact on urinary protein excretion-protein:creatinine ratio 2.5+/-1.0 pre versus 2.4+/-1.2 post antioxidant. Vitamin E supplementation had no effect on glomerular filtration rate, serum albumin, or cholesterol concentration in either group of patients. These findings suggest that reactive oxygen molecules may play a more-prominent role in causing renal injury in patients with FSGS than in other kidney disorders. Antioxidant therapy may be a useful adjunct in the treatment of children with FSGS and proteinuria that is refractory to standard medical management.


Giorgio Bartolozzi
Membro della Commissione Nazionale Vaccini, Università di Firenze
venerdì, 29 Gennaio 2010, ore 11:41