Effect of sulodexide on markers of endothelial injury in patients with glomerulonephritis: results of a prospective cohort study

Objective — to evaluate the endothelioprotective effects of sulodexide in patients with glomerulonephritis (GN) by assessing the dynamics of daily proteinuria and urinary markers of endothelial injury, including thrombomodulin (TM) and von Willebrand factor (VWF). Materials and methods. A prospective observational study was conducted at Ivano‑Frankivsk Regional Clinical Hospital between 2022 and 2024. The cohort included 85 patients with biopsy‑proven GN, divided into two groups: Group I (n=42) received standard therapy, and Group II (n=43) received standard therapy plus sulodexide. The control group comprised 20 practically healthy individuals. Urinary and serum levels of TM and VWF were measured by ELISA, and daily proteinuria was assessed at baseline, after 1 month, and after 6 months of treatment. Statistical analysis involved Student’s t‑test, Mann–Whitney U test, and correlation analysis, with p<0.05 considered significant. Results. After 1 month, no significant differences were observed in urinary TM, VWF, or proteinuria in either treatment group (p > 0.05). At 6 months, patients in Group II demonstrated a significant reduction in urinary TM (p=0.021), VWF (p=0.001), and daily proteinuria (p=0.001), while in Group I only non‑significant trends were noted (p > 0.05). Between‑group comparisons confirmed efficacy of sulodexide (p=0.034). Sulodexide was well tolerated, with mild, self‑limiting adverse events reported in 20.9% of patients. Conclusions. Long‑term therapy with sulodexide exerts significant endothelioprotective and nephroprotective effects in GN patients, manifested by reductions in urinary TM, VWF, and proteinuria. These findings support sulodexide as a promising adjunctive therapy for slowing renal disease progression, although confirmation in larger randomized controlled trials is warranted.