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The Journal of the Royal Institute of Thailand Volume II - 2010 Prasit Futrakul, Narisa Futrakul 89 synthase, and therefore enhance nitric oxide production. Enhanced nitric oxide production would facilitate the renal microvessels response to vasodilators, and therefore increase renal perfusion and eventually enhance renal function. An appropriate therapeutic strategy to restore renal perfusion and function in early stage of diabetic nephropathy In accordance with the preceding information, the normal status of mechanism of vascular repair observed in early stage of diabetic nephropathy would be suitable for the process of enhancing renal perfusion and renal regeneration. A correction of renal ischemia would inhibit the degenerative process, and allow the regenerative arm of vascular homeostasis to take place. Improved renal perfusion would induce the reparative process of the nephronal structure. 5-7 This view is supported by (1) the improvement in the fractional excretion of magnesium — an index reflecting the suppression in the magnitude of tubulointerstitial fibrosis following treatment with vasodilators. (ii) the improvement in creatinine clearance. This successful restoration of renal perfusion and function implies that an effective preventive strategy to minimize end-stage renal failure could be accomplished under this new conceptual view of early treatment in diabetes mellitus. Acknowledgement This study is supported by the Thailand Research Fund and the National Research Council Fund of Thailand and the Thai Royal Society. References 1 Futrakul N, Sila-asna M, Futrakul P, 2007. A therapeutic strategy towards restore renal function in chronic kidney disease. Asian Biomed, 1:33-44. 2 Futrakul N, Yenrudi S, Sensirivatana R, Sensirivatana R, Watana D, Laohapaibul A, Watanapenphaibul K, Futrakul S, 2000. Peritubular capillary flow determinestubulointerstitial disease in idiopathic nephritic syndrome. Ren Fail, 22:329-335. 3 Futrakul N, Butthep P, Futrakul P, 2009. Altered vascular homeostasis in type 2 diabetic nephropathy. Ren Fail , 31:207-310. 4 Futrakul N, Futrakul P, 2010. An adequate vascular repair in normooalbuminuria type 2 diabetic nephropathy. Asian Biomed 2010 ; 4:153-157.