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Abstrak :
Latar Belakang: Hiperglikemia kronik pada diabetes akan menyebabkan peningkatan produksi reactive oxygen species ROS yang berkontribusi terhadap progresifitas nefropati. Kurkumin telah terbukti memiliki khasiat renoprotektif pada nefropati diabetik melalui efek antioksidan. Tetapi, kurkumin memiliki kekurangan yaitu, bioavailabilitas rendah, metabolisme lintas pertama yang ekstensif, dan kelarutan yang buruk. Penelitian ini bermaksud untuk mengetahui efek kurkumin dalam bentuk nanopartikel nanokurkumin terhadap tikus diabetes yang diinduksi Streptozotocine-Nikotinamide terhadap progresifitas nefropati melalui hambatan stress oksidatif. Metode: Tikus jantan Sprague Dawley diinduksi diabetes melalui pemberian Nikotinamide 100 mg/kg , dilanjutkan dengan Streptozotocine 55 mg/kg , dosis tunggal, intraperitoneal. Kemudian, tikus dibagi menjadi 4 kelompok; normal, DM tanpa treatment, DM treatment kurkumin 100 mg/kg, dan DM treatment nanokurkumin 100 mg/kg, selama 30 hari. Fungsi fisiologis dinilai berdasarkan BB, GDP, dan rasio berat ginjal. Fungsi ginjal dinilai berdasarkan klirens kreatinin, BUN, dan proteinuria. Kerusakan histologis dinilai dari scoring pewarnaan HE. Stress oksidatif diukur dari kadar malondialdehyde MDA dan kadar superoxide dismutase SOD. Hasil: Meski tidak signifikan, pemberian nanokurkumin menunjukkan efek yang lebih baik daripada pemberian kurkumin berdasarkan parameter SOD, GDP, berat badan, rasio berat ginjal, klirens kreatinin, protein urin, dan gambaran histopatologi. Pemberian nanokurkumin secara signifikan menurunkan kadar BUN. Kesimpulan: Setelah 30 hari pemberian nanokurkumin 100 mg/kg BB maupun kurkumin dengan dosis sama tidak dapat menurunkan stress oksidatif, namun dapat mencegah progresifitas nefropati diabetikum. ...... Background: Chronic hyperglycaemia in diabetes leads to the overproduction of reactive oxygen species ROS that these contribute to the development of diabetic nephropathy. Curcumin, has been recently discovered to have renoprotective effects on diabetic nephropathy DN through its antioxidant properties. However, low peroral bioavailability, extensive first pass metabolism, and low solubility is a major limiting factor for the success of clinical utilization of curcumin. The present study was undertaken to examine the effect of curcumin formed in nanoparticles nanocurcumin treatment in Streptozotocine Nicotinamide induced diabetic rat on the progressivity of nephropathy through its stress oxidative inhibition. Method: Diabetes was induced by Nicotinamide 100 mg kg followed by Streptozotocine 55 mg kg, single dose, intraperitoneal, in male Sprague Dawley rats. Then rats divided into four groups, namely normal, diabetic, diabetic treated with curcumin 100 mg kg, and diabetic treated with nanocurcumin 100 mg kg for 30 days. Physiological function was assessed by body weight, FBG, and kidney weight ratio. Renal function was assessed by creatinine clearance, BUN, and proteinuria. Diabetic renal damage was determined by Hematoxyclin Eosin HE staining. Oxidative stress was measured by renal malonaldehyde MDA level, and superoxide dismutase SOD level. Result: Although did not significant, nanocurcumin showed better effect than curcumin based on SOD, FBG, body weight, kidney weght ratio, creatinine clearance, proteinuria, and renal histopathological changes. Nanocurcumin showed significant decreases in BUN level. Conclusion: After 30 days of treatment, both nanocurcumin and curcumin 100 mg kg did not decreases oxidative stress but showed inhibition in progressivity of nephropathy.

Abstrak :
Nefropati diabetik merupakan komplikasi DM tipe 2 yang umumnya ditandai dengan kondisi albuminuria dari hasil penilaian UACR. TGF-β1 urin merupakan faktor pertumbuhan yang banyak dikaitkan dengan patologis dari kerusakan ginjal pada nefropati diabetik. Tujuan dari penelitian ini yaitu untuk mengetahui hubungan nilai UACR dengan kadar TGF-β1 urin pada pasien DM tipe 2. Desain studi pada penelitian ini yaitu cross sectional dimana pengambilan sampel menggunakan teknik consecutive sampling. Sampel yang diperoleh berjumlah 99 subjek penelitian (62 pasien DM normolbuminuria, 27 pasien DM albuminuria, dan 10 subjek non DM sebagai kontrol) di Puskesmas Kecamatan Pasar Minggu. Kadar TGF-β1 urin diukur menggunakan ELISA, sedangkan nilai UACR diperoleh dari hasil uji laboratorium klinik. Hasil dari uji beda rerata pada kadar TGF-β1 urin menunjukkan tidak terdapat perbedaan bermakna (p = 0,790) pada ketiga kelompok sampel. Hasil analisis hubungan kadar TGF-β1 urin dengan nilai UACR pada kelompok DM normoalbuminuria dan albuminuria juga menunjukkan tidak adanya hubungan yang bermakna (r = -0,079; p = 0,462). Hal ini diduga adanya pengaruh tekanan darah dan konsumsi obat antihipertensi yang berpotensi mempengaruhi kadar TGF-β1 urin. Oleh karena itu, dapat disimpulkan bahwa kadar TGF-β1 urin dengan nilai UACR tidak terdapat hubungan yang signifikan pada pasien DM tipe 2. ......Diabetic nephropathy is one of type 2 DM complication that can be detected by UACR (Urine Albumin Creatinine Ratio) as a marker for albuminuria condition. Urinary transforming growth factor β1 (TGF-β1) is a growth factor related to pathology of kidney disease in nepropathy diabetic. The aim of the present study was to know the correlation between TGF-β1 and UACR in type 2 DM patients. Design study was using cross sectional with consecutive sampling method. The study was performed in 99 subjects (62 DM normolbuminuria patients, 27 DM albuminuria patients, and 10 non DM subject as controls) at Pasar Minggu Community Health Center. Urinary TGF-β1 level was measured by ELISA, and UACR was measured in clinical laboratory. The result of mean difference test showed that urinary TGF-β1 level (p = 0,790) difference were not present in three group samples. Analysis correlation urinary TGF-β1 level and UACR in DM normoalbuminuria and albuminuria groups did not show correlation (r = -0,079; p = 0,462), and the result might influenced by blood pressure and received antihypertention medication that potent to reduce urinary TGF-β1 level. In conclusion, urinary TGF-β1 level and UACR did not have significant correlation in type 2 DM patients.

Abstrak :
ABSTRAK
Gagal ginjal kronik merupakan salah satu masalah kesehatan masyarakat perkotaan dengan prevalensi kasus yang terus meningkat. Salah satu penyebab utama gagal ginjal kronik adalah nefropati diabetik. Mekanisme nefropati diabetik menyebabkan ginjal mengalami penurunan fungsi ginjal yang ditandai dengan penurunan laju filtrasi glomerolus. Hal tersebut menyebabkan berbagai masalah seperti kelebihan volume cairan yang memiliki berbagai komplikasi seperti edema paru akut dan neuropati perifer. Fokus penanganan masalah yaitu pada pengaturan balans cairan, pengontrolan glukosa darah dan pencegahan neuropati diabetik perifer. Hasil intervensi yang dilakukan selama 6 hari menunjukkan terjadi balans cairan negatif hingga mendekati keseimbangan cairan, ditandai dengan edema hilang dari derajat 3 menjadi 0 dan pertukaran gas di paru adekuat. Pencegahan neuropati diabetik dilakukan dengan latihan senam kaki. Hasilnya terjadi peningkatan pengetahuan mengenai cara pencegahan neuropati diabetik perifer. Oleh karena itu, intervensi pengaturan balans cairan, pengontrolan glukosa darah dan pencegahan neuropati diabetik perifer sangat penting dilakukan pada pasien gagal ginjal kronik akibat nefropati diabetik.

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ABSTRACT
Chronic kidney disease is one of the urban health problems which prevalence is growing progressively. Diabetic nephropathy is the common cause of chronic kidney disease. The mechanism of diabetic nephropathy leads to decreased kidney functions and abilities that shown in decreased Gromerolus Filtration Rate GFR . Fluid overload and other complications such as acute lung oedema and peripheral diabetic neuropathy may occur afterall. The main interventions to overcome this problem are regulating fluid balance, controlling blood glucose and preventing peripheral diabetic neuropathy. After conducting nursing care within 6 days, patient showed good fluid balance with absence of edema decreased of edema scale from grade 3 to grade 0 and adequate gasses exchange in the lung. Foot exercise was also done as prevention of peripheral diabetic neuropathy. There was an increased patient rsquo s and family rsquo s knowledge about how to prevent peripheral diabetic neuropathy. Therefore all the nursing interventions mentioned above are highly recommended to be applied in nursing care to patient with chronic kidney disease due to diabetic nephropathy.

Abstrak :
Diabetes mellitus DM dapat menyebabkan kerusakan ginjal dan nefropati diabetik merupakan penyebab gagal ginjal tersering. Penelitian ini bertujuan untuk mengetahui jumlah sel epitel tubulus ginjal dalam sedimen urin yang dapat dijadikan penanda kerusakan ginjal pada penderita DM. Penelitian ini juga bertujuan mencari nilai cut off jumlah sel epitel tubulus ginjal sebagai penanda kerusakan ginjal pada penderita DM, korelasi antara jumlah sel epitel tubulus ginjal dengan urine albumin/creatinine ratio UACR dan ?2-microglobulin urin serta korelasi antara ?2-microglobulin serum dengan UACR. Desain penelitian adalah potong lintang deskriptif analitik dengan 90 subjek, penelitian berlangsung selama Juni hingga Oktober 2017. Sampel menggunakan urin dan serum penderita diabetes mellitus. Jumlah sel epitel tubulus ginjal diperiksa dengan Sysmex UF-4000. Kadar albumin urin diperiksa dengan NycoCard. Kadar ?2-microglobulin serum dan urin serta kreatinin urin diperiksa dengan Cobas C501. Hasil penelitian didapatkan perbedaan bermakna jumlah sel epitel tubulus ginjal pada kelompok nefropati diabetik dengan non nefropati diabetik 2,4 sel /?L vs 1,6 sel /?L . Tidak ada korelasi antara jumlah sel epitel tubulus ginjal dengan UACR dan ?2-microglobulin urin. Korelasi antara ?2-microglobulin serum dengan UACR adalah lemah dan bermakna.

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Diabetes mellitus DM can cause kidney damage and diabetic nephropathy is the most common cause of renal failure. This study aimed to determine the number of renal tubular epithelial cells in urine sediments that could be used as a marker of kidney damage in patients with DM. This study also aimed to determine cut off point of renal tubular epithelial cells as a marker of kidney damage in patients with DM, the correlation between the renal tubular epithelial cells with urine albumin creatinine ratio UACR and 2 microglobulin urine and the correlation between serum 2 microglobulin and UACR. The study design was cross sectional, descriptive analytic with 90 subjects, the study took place during June to October 2017. The sample used urine and serum of diabetic patients. The renal tubular epithelial cells was examined with Sysmex UF 4000. Urinary albumin levels are determined with NycoCard. Serum 2 microglobulin and urine and urinary creatinine levels were determined with Cobas C501. The results showed significant differences in number of renal tubular epithelial cells in the diabetic nephropathy group with non diabetic nephropathy 2.4 cells L vs. 1.6 cells L . There was no correlation between the number of renal tubular epithelial cells with UACR and urine 2 microglobulin. The correlation between serum 2 microglobulin with UACR was weak and significant.

Abstrak :
ABSTRAK
Nefropati diabetika dapat dideteksi melalui nilai UACR. Di sisi lain, 8-iso- Prostaglandin F2α sedang diteliti perannya sebagai penanda awal disfungsi ginjal. Penelitian ini bertujuan untuk menganalisis kadar 8-iso-Prostaglandin F2α, UACR serta hubungan 8-iso-Prostaglandin F2α dan UACR pada 72 orang pasien diabetes melitus tipe 2 (usia 33-75 tahun) di Puskesmas Kecamatan Pasar Minggu. Sampel penelitian dibagi menjadi 2 kelompok, yaitu kelompok biguanid (n = 36) dan kelompok biguanid-sulfonilurea (n = 36). Kadar 8-iso-Prostaglandin F2α urin diukur menggunakan ELISA dan albumin urin diukur menggunakan kit BCG Albumin. Hasil uji beda rata-rata menunjukkan tidak terdapat perbedaan kadar 8-iso- Prostaglandin F2α (p = 0,083) dan UACR (p = 0,509) pada kedua kelompok sampel. Hasil uji beda rata-rata pada kelompok sampel dengan albuminuria (n = 33) juga menunjukkan tidak terdapat perbedaan kadar 8-iso-Prostaglandin F2α (p = 0,532) dan UACR (p = 0,067). Hubungan antara kadar 8-iso-Prostaglandin F2α dengan UACR pada seluruh sampel (r = 0,120; p = 0,315), sedangkan antara 8-iso- Prostaglandin F2α dengan UACR pada kelompok albuminuria (r = 0,534; p = 0,001). Jadi, tidak terdapat hubungan yang signifikan antara kadar 8-iso-Prostaglandin F2α dengan UACR pada seluruh sampel, tetapi terdapat hubungan yang cukup kuat dan signifikan antara kadar 8-iso-Prostaglandin F2α dengan UACR pada sampel dengan albuminuria.

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ABSTRACT
Diabetic nephropathy can be detected by UACR value. Meanwhile, 8-iso- Prostaglandin F2α is being studied for its role as early marker for renal dysfunction. This study were to analize 8-iso-Prostaglandin F2α, UACR, and the correlation between 8-iso-Prostaglandin F2α and UACR on 72 type 2 diabetes mellitus patient (from ages: 33-75 years) at Pasar Minggu Community Health Center. Samples were divided into two groups, which was biguanid group (n = 36) and biguanidsulfonylurea group (n = 36). Urinary 8-iso-Prostaglandin F2α was measured by ELISA and urinary albumin by BCG Albumin kit. The results of mean different test showed there were no difference for 8-iso-Prostaglandin F2α (p=0,083) and UACR (p=0,509) in two group samples. The results of mean different test showed there were also no difference for 8-iso-Prostaglandin F2α (p=0,532) and UACR (p=0,067) in group samples with albuminuria (n=33). The correlation between 8-iso- Prostaglandin F2α and UACR on total samples (r = 0,120; p = 0,315), meanwhile the correlation between 8-iso-Prostaglandin F2α with UACR on samples with albuminuria (r = 0,534; p = 0,001). So, there was no significant correlation between 8-iso-Prostaglandin F2α and UACR on total samples, meanwhile there was strong enough and significant correlation between 8-iso-Prostaglandin F2α and UACR on samples with albuminuria.

Abstrak :
Nefropati diabetik telah diketahui merupakan salah satu penyulit jangka panjang diabetes melitus (DM) yang berbahaya, yang dapat menyebabkan kegagalan ginjal tahap akhir. Namun, data adanya nefropati diabetik di antara pasien diabetes tipe 2 yang menjalani rawat jalan saat ini belum ada. Penelitian cross-sectional ini ditujukan untuk mengetahui prevalensi nefropati diabetik di antara penderita diabetes tipe 2 rawat jalan yang datang untuk pertama kalinya ke Klinik Metabolik dan Endokrinologi, RSUPN Dr. Cipto Mangunkusumo, Jakarta. Dari Desember 2001 sampai Juni 2002, 100 pasien baru diabetes tipe 2 diikutsertakan dalam studi. Empat puluh dua di antaranya adalah laki-laki dengan usia rata-rata 54 + 9,6 tahun. Overt nephropathy (makroalbuminuria) ditemukan pada 11% pasien, incipient nephropathy (mikroalbuminuria) terdapat pada 26% penderita, sedangkan sisanya normal (normoalbuminuria). Hasil penelitian menunjukkan bahwa lama sakit yang lebih dari 5 tahun menunjukkan korelasi bermakna dengan derajat albuminuria. Namun, tidak ada hubungan bermakna antara derajat albuminuria dengan faktor-faktor risiko lain, yaitu usia, dislipidemia, hipertensi, obesitas, dan kadar HbA1c. Semua pasien dengan overt nephropathy menunjukkan tes klirens kreatinin di bawah 75 ml/ menit (rerata 45,3 mL/menit), secara bermakna lebih rendah dari pasien dengan mikro- atau normoalbuminuria (p=0,01). Retinopati ditemukan pada 10 dari 11 (90%) pasien dengan overt nephropathy. Analisis multivariat memperlihatkan bahwa lama sakit dan retinopati secara bermakna berkorelasi dengan terjadinya nefropati diabetik (p < 0,05). Sebagai kesimpulan dapat dikatakan bahwa prevalensi nefropati diabetik (yaitu overt nephropathy dengan retinopati) di antara pasien diabetes tipe 2 rawat jalan adalah 10%. Lama sakit merupakan faktor risiko penting bagi timbulnya penyulit ini. (Med J Indones 2004; 13: 161-5)

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Diabetic nephropathy has been known as one of the most serious long-term complications of diabetes mellitus (DM), which could lead to end-stage kidney failure. However, data showing the presence of diabetic nephropathy among ambulatory type 2 diabetic patients is currently not available. This cross-sectional study was conducted to find the prevalence of diabetic nephropathy among non-hospitalized type 2 diabetic patients, who came for the first time to the Metabolic and Endocrinology Clinic, Dr. Cipto Mangunkusumo Hospital, Jakarta. From December 2001 to June 2002, 100 new type 2 diabetic patients were included in the study. Forty-two of them were men and the mean age was 54 + 9.6 years. Overt nephropathy (macroalbuminuria) was found in 11% of patients, while incipient nephropathy (microalbuminuria) was 26%, and the rest were normal (normoalbuminuria). Duration of illness of more than 5 years was significantly correlated with the degree of albuminuria. However, there is no significant correlation between the degree of albuminuria and other risk factors, i.e. patient’s age, dyslipidemia, hypertension, obesity, HbA1c level. All patients with overt nephropathy had creatinine clearance test below 75 ml/ min. (mean 45.3 mL/min), significantly lower than patients with micro- or normoalbuminuria (p=0.01). Retinopathy was found in 10 out of 11 (90%) patients with overt nephropathy. Multivariate analysis showed that the duration of illness and retinopathy was significantly correlated with the presence of diabetic nephropathy (p< 0.05). We concluded that the prevalence of diabetic nephropathy (i.e. overt nephropathy with retinopathy) among non-hospitalized type 2 diabetic patients was 10%. The duration of illness was an important risk factor for the development of this complication. (Med J Indones 2004; 13: 161-5)

Abstrak :
Malondialdehida merupakan produk peroksidasi lipid yang diduga bertanggung jawab sebagai penyebab terjadinya nefropati diabetik. Penelitian ini menilai hubungan antara kadar malondialdehida serum dengan UACR dan laju filtrasi glomerulus sebagai parameter fungsi ginjal. Penelitian ini menggunakan 54 pasien diabetes melitus tipe 2 sebagai sampel (3 laki-laki dan 51 perempuan, rentang usia 42-74 tahun). Kadar malondialdehida serum diukur secara spektrofotometri menggunakan asam tiobarbiturat. Laju filtrasi glomerulus diperoleh dari nilai kreatinin serum. Kreatinin urin diukur dengan metode Jaffe dan albumin urin diukur dengan metode bromkresol hijau. Kadar malondialdehida pasien diabetes diperoleh sebesar 2,46 ± 2,58 nmol/mL; nilai UACR sebesar 42,32 ± 76,67; dan nilai laju filtrasi glomerulus sebesar 104,75 ± 46,16 (Cockroft-Gault); 89,52 ± 25,86 (MDRD study); dan 99,49 ± 46,11 (CKD-EPI). Hasil analisis hubungan antara malondialdehida dengan Cockroft-Gault (p = 0,491, r = -0,096); MDRD study (p = 0,618, r = -0,069); CKD-EPI (p = 0,611, r = -0,071); UACR (p = 0,583, r = 0,076). Ditemukan hubungan yang bermakna antara nilai UACR dengan laju filtrasi glomerulus Cockroft-Gault (p = 0,019, r = -0,318); MDRD study (p = 0,007, r = -0,361); CKD-EPI (p = 0,010, r = -0,348). Tidak ditemukan hubungan yang bermakna antara malondialdehida dengan laju filtrasi glomerulus dan UACR. ...... Malondialdehyde is a product of lipid peroxidation that is suspected as a cause of diabetic nephropathy. This study assessed the relation between malondialdehyde level with UACR and glomerular filtration rate as renal function parameters. This study is using 54 patients type 2 diabetes mellitus as samples (3 men and 51 women, age range 42-74 years). Malondialdehyde was measured by spectrophotometry using tiobarbiturat acid. Glomerular filtration rate was obtained from serum creatinine value. Urine creatinine was measured based on Jaffe method and urine albumin was measured with bromcressol green. Malondialdehyde level of diabetic patients was 2.46 ± 2.58 nmol/mL; UACR was 42.32 ± 76.67; and glomerular filtration rate were 104.75 ± 46.16 (Cockroft-Gault); 89.52 ± 25.86 (MDRD study); and 99.49 ± 46.11 (CKD-EPI). The analysis result of the relationship between malondialdehyde and Cockroft-Gault (p = 0.491, r = -0.096); MDRD study (p = 0.618, r = -0.069); CKD-EPI (p = 0.611, r = -0.071); and UACR (p = 0.583, r = 0.076) . There were significant correlation between UACR and glomerular filtration rate Cockroft-Gault (p = 0.019, r = -0.318); MDRD study (p = 0.007, r = -0.361 ); CKD-EPI (p = 0.010, r = -0.348). There were no significant correlation between malondialdehyde level and glomerular filtration rate or UACR.

Abstrak :
Disfungsi ginjal adalah salah satu komplikasi kronik pada pasien diabetes melitus tipe 2 DM tipe 2 yang diketahui sebagai nefropati diabetik. Salah satu penanda yang digunakan sebagai pendeteksi kerusakan ginjal adalah rasio albumin kreatinin UACR. Selain UACR, kolagen tipe IV banyak diteliti terkait fungsinya sebagai pendeteksi awal nefropati diabetik. Tujuan penelitian ini adalah untuk menilai perbedaan UACR, kadar kolagen tipe IV urin, serta mengetahui hubungan keduanya pada pasien yang menerima terapi angiotensin-converting enzyme inhibitors ACEI dan angiotensin receptor blockers ARB sebagai kelas yang menghambat perkembangan nefropati diabetik pada pasien DM tipe 2. Penelitian dilakukan dengan menggunakan studi cross sectional dan teknik pengambilan consecutive sampling. Terdapat dua kelompok dalam penelitian ini, pasien dengan terapi ACEI n = 14 dan ARB n = 26. Kolagen tipe IV urin dianalisis dengan menggunakan ELISA kit. Albumin dan kreatinin urin diukur dengan menggunakan metode imunoturbidimetri dan kolorimetri. Kadar kolagen tipe IV urin dihitung dengan normalisasi pengukuran kolagen tipe IV urin dengan kadar kreatinin urin. Pada nilai UACR, rerata kedua kelompok ACEI = 276,61 65,119 g/mg kreatinin urin; ARB = 87,25 24,743 g/mg kreatinin urin menunjukkan perbedaan bermakna p = 0,019, kedua kelompok ACEI = 117,14 37,36 ng/mg kreatinin urin; ARB = 14,19 1,46 ng/mg kreatinin urin juga menunjukkan perbedaan bermakna pada kadar kolagen tipe IV urin p < 0,001. Uji korelasi antara nilai UACR dan kadar kolagen tipe IV urin menunjukkan hubungan moderat pada kedua kelompok penelitian r = 0,489; p = 0,001. Hasil menunjukkan bahwa kelompok ARB memiliki tingkat kolagen tipe IV urin yang lebih rendah dibandingkan dengan ACEI, sehingga terapi dengan ARB kemungkinan dapat menghambat perkembangan nefropati diabetik. ......Renal dysfunction is one of chronic complications in type 2 diabetes mellitus patients T2DM known as diabetic nephropathy DN. Urine albumin creatinine ratio UACR is a widely used test for detection of DN. Beside of UACR, type IV collagen has been studied to its function as an early detection of DN. The aim of this study was to compare differences in UACR, urinary type IV collagen, and their correlation in patients with angiotensin converting enzyme inhibitors ACEI versus angiotensin receptor blockers ARB treatment as classes with respect to delay the development of DN in patients with type 2 diabetes by using cross sectional study and consecutive sampling method. There were 2 groups in this study, patients with ACEI n 14 and ARB therapy n 26. Urinary type IV collagen were analyzed using ELISA kit. Urine albumine and urine creatinine was measured by using immunoturbidimetry and colorimetric method. Urinary type IV collagen levels were calculated by normalizing type iv collagen with urine creatinine levels. Results showed that UACR ACEI 276,61 65,119 g mg urine creatinine ARB 87,25 24,743 g mg urine creatinine showed significant differences p 0.019, urinary type IV collagen ACEI 117,14 37,36 ng mg urine creatinine ARB 14,19 1,46 ng mg urine creatinine showed significant differences p 0.001. Correlation between UACR and urinary type IV collagen presented a moderate correlation in both studied groups r 0.489 p 0.001. The results showed that group with ARB treatment have lower level of urinary type IV collagen compared to groups with ACEI treatment, conclude that ARB more likely to inhibit the development of DN.