Prof. ahmady ismail :: Publications:

This double blinded placebo-controlled intervention study aimed to assess the effect of antioxidants supplementation in the management of childhood nephrotic syndrome. It was carried out in the Pediatric Department of Zagazig University Hospital during the period from July 2003 to December 2003. The target sample comprised 60 nephrotic patients (active nephrotic syndrome in the first attack), of age range from 5 to 8 years. The intervention consisted of a Prednisone 2 mg/kg/day, on 3 divided doses, orally in combination with either antioxidant capsules (Antioxidant plus capsules) or placebo capsules. Children included were matched together regarding age , sex and on the same regimen of corticosteroid therapy .They were categorized by systematic random sampling into two equal groups. Group I: included 30 nephrotic patients received the antioxidant capsules at a dose of one capsule per day orally , providing an antioxidant formula of Vitamin E 30mg,VitaminC 250 mg,  carotene 3mg, Zinc 7.5 mg, Copper 1mg, Manganese 1.5mg, and Selenium 15 gm. Group II: included the other 30 nephrotic patients and received the placebo capsules. The intervention continued for one month with daily follow up after initiation of treatment and until complete remission occurred on clinical and laboratory basis (otherwise excluded from the study). Pre and post- intervention data were presented and analyzed . The results of this study revealed that the difference in the mean serum levels of oxidants(MDA, nitric oxide) , antioxidants( vitamin E, vitamin C, zinc, selenium, glutathione and catalase activity in RBCs) and laboratory findings (albumin, total protein, urea, creatinine, cholesterol and total protein in 24 hours urine)between studied groups in the pre intervention period were statistically insignificant (P>0.05).Adding antioxidants supplement (antioxidant plus capsules) at a dose of one capsule per day to a corticosteroid regimen in group I (antioxidant group) leads to a significant reduction in the mean levels of serum oxidants (MDA, nitric oxide) from 23.62.6 mol/l and 5.4 2.9 mol/l pre intervention to 16.6  2.76 mol/l and 3.8 1.9 mol/l post intervention (P < 0.001) respectively, while the mean levels of the antioxidants: vitamin E, vitamin C, zinc, selenium ,glutathione and catalase activity had been significantly increased from 8.71.5 gm/dl, 0.860.94 mg/l,60.58.6gm/dl,4.71.3gm/dl,6.121.4umol / gmHb and12.32.4unit/gmHb pre intervention to12.33.2 gm/dl,2.71.95mg/l,86.1 11.2 gm/dl, 10.7 1.7 gm/dl, 7.46 0.77umol/gm Hb and 19.043.9 unit/gmHb post intervention(P < 0.001) respectively. Also the mean serum levels of albumin, protein , urea ,creatinine and cholesterols in group I had been significantly improved from 2.13 0.49 gm%, 5.73  0.77gm%, 48.1  18.5mg/dl , 0.740.26mg/dl and 300.5  78.7 mg/dl in the pre intervention stage to 3.36 ± 0.93 gm%,7.12 ± 0.7 gm%, 36.87 ± 14.2 mg/dl, 0.449±0.15 mg/dl and 235 ± 54.3 mg/dl in the post intervention stage (P < 0.001) respectively. This improvement is still higher than that observed in the placebo group where the mean serum levels of malondialdehyde, nitric oxide, vitamin E, vitamin C, zinc, selenium, glutathione and catalase activity had been insignificantly decreased from 22.7 3.2 mol/l, 5.6  2.6 mol/l, 8.3 2.0 gm/dl, 0.72 0.83 mg/l, 58.87 10.9gm/5.1 dl, 1.6 gm/dl,5.9 1.8umol/gm Hb and11.13.99 unit/gmHb pre intervention to 19.43.68 mol/l, 5.322.3mol/l, 7.21  2.5 gm/dl, 0.68 1.2 mg/l, 57.648.1 gm/dl,4.761.1 gm/dl 5.6 2.1 umol/gm Hb and 9.8  2.1 unit/gmHb post intervention (P>0.05) respectively, although The mean serum levels of albumin and protein had been significantly improved from 2.170.58gm% and 5.61 0.68 gm% pre intervention to 2.73 ±0.74 gm% and 6.31 ±0.9 gm% post intervention (P