Famous traditional Mongolian medicine Xieriga-4 (Turmeric-4) decoction: A review / 中草药·英文版

Xieriga-4 Decoction, composed of dried rhizomes of Curcumae longae, barks of Phellodendron chinense or Phellodendron amurense, fruits of Cardenia jasminoides, and fruits of Tribulus terrestris, is a famous prescription of traditional Mongolian medicine for the treatment of urinary system diseases such as frequent urination, urgent urination, urine occlusion, hematuria, bladder irritation and pain. This paper reviewed Xieriga-4 Decoction from the aspects of historical description, prescription principle, chemical components, pharmacology, clinical application and quality control.

Tripterygium wilfordii in Treatment of Kidney Diseases and Its Toxic and Side Effect： A Review / 中国实验方剂学杂志

In recent years， with the rapid development of traditional Chinese medicine industry in China， the efficacy of Chinese medicinals in treating disease and maintaining health has been increasingly recognized. Tripterygium wilfordii， a Chinese medicinal for expelling wind， dredging collaterals， removing dampness， and relieving pain， is commonly used for treating acute and chronic glomerulonephritis， rheumatoid arthritis， and other diseases. However， the frequent occurrence of adverse reactions has limited its wide application in clinical practice. The existing studies have gradually confirmed that T. wilfordii and its active ingredients exert the bidirectional effects on kidney function. This paper reviewed the related clinical applications and articles published in the past decades and summarized the material basis for its bidirectional effects and the specific action mechanisms in renal protection and renal damage. It was found that the main active ingredients in T. wilfordii were tripterygium glycosides and triptolide， which exerted the protective or toxic and side effects on kidney by regulating immunity， influencing mitogen-activated protein kinases （MAPK） pathway， and changing the expression and function of renal transporters. Besides， the roles of administration time， dosage， and body status in the exertion of protective or toxic and side effects by T. wilfordii were also discussed. The review aimed to provide new ideas for the research on the treatment of kidney diseases with T. wilfordii and its safety application.

Effect of Modified Shengjiangsan on Renal Protection for Membranous Nephropathy Rats and Expression of ROS / 中国实验方剂学杂志

Objective: To detect the effect of modified Shengjiangsan on the expression of reactive oxygen species(ROS) in mitochondria of renal foot cells of rats, in order to study the mechanism of modified Shengjiangsan. Method: After be fed for 7 days,the 60 SD male rats were randomly divided into four groups:blank control group, model group, positive medicine group and traditional Chinese medicine(TCM) treatment group. After establishment of the rat model of membranous nephropathy, model group, positive medicine group and TCM treatment group were treated differently. After 4 weeks, all of the rats were put to death, and the expressions of ROS, 24-hour urinary protein quantity,total cholesterol,triglyceride,total protein,albumin,urea nitrogen,creatinine were detected by Real-time fluorescence quantitative polymerase chain reaction Real-time PCR. Result: The expression of 24-hour urinary protein quantity,total cholesterol,triglyceride in positive medicine group and TCM treatment group were reduced,and the expressions of total protein,albumin in positive medicine group and TCM treatment group were reduced compared with those of model group (PPConclusion: Modified Shengjiangsan can effectively control the development of ROS in mitochondria of renal foot cells of rats, and repair the renal function of membranous nephropathy rats by recovering foot cells.

Non-hypoglycemic effect of metformin in renal protection:a literature review / 中国药理学通报

The effectiveness,safety and economy of metformin on type 2 diabetes mellitus therapy are well recognized, which has been used as the first-line oral hypoglycemic agent in recent dec-ades. Apart from hypoglycemic effect, recent studies show that metformin can exert renal protection via the mechanisms of auto-phagy induction, anti-senescence, antioxidative stress, against endoplasmic reticulum stress,anti-inflammation, and anti-fibro-sis through AMPK dependent or independent pathway, which prompt its therapeutic potential in acute kidney injury and chron-ic kidney disease. The non-hypoglycemic nephroprotective effects as well as their underlying mechanisms of metformin are summarized in this review.

Mesenchymal stem cell isolation,identification and protection mechanism in kidney of diabetic rats / 中国免疫学杂志

Objective:To observe the bone marrow mesenchymal stem cell isolation,identification methods and protection mechanisms in the kidney of diabetic rats.Methods: Thirty-one rats were used to isolate bone marrow mesenchymal stem cells (BMSCs) by adherent culture method.Cell morphology was observed by phase contrast microscope.The surface molecular weight of cultured cells was detected by Real-time PCR.30 rats were induced by intraperitoneal injection of streptozotocin to establish diabetic rat model (n=15).And stem cell treatment group (n=15) according to the different treatment methods.Rats in the control group were treated with insulin combined with probucol.Stem cell treatment group was implanted with stem cells.Before and after treatment,fasting blood glucose,24 h urinary protein excretion,creatinine clearance rate and kidney weight were measured.PAS staining.And the renal tissue was detected by Western blot.Results: The primary bone marrow mesenchymal stem cells (MSCs) were cultured for 24 hours,and the cells were irregularly distributed in the culture flask.After 7 days of culture,the cells were regular,elongated,elliptical,and strong refraction,and the cells were fused with each other.The morphology of BMSCs was uniform and showed a long fusiform shape,CD44,CD31 and CD34 were observed by RT-PCR.The levels of fasting blood glucose,24 h urine protein excretion and creatinine clearance rate in the observation group were significantly higher than those in the control group (P0.05).Conclusion: It is suggested that BMSCs can be isolated from rat bone marrow mesenchymal stem cells by using adherent culture method and labeled with green fluorescent protein in vitro.Bone marrow mesenchymal stem cells can protect the kidney and inhibit the oxidative stress of diabetic kidney.

Protective effect of Sika deer velvet antler protein on cisplatin-induced kidney injury / 中国药理学与毒理学杂志

OBJECTIVE To investigate the protective effect of Sika deer velvet antler protein (SVPr) against renal toxicity in mice and its mechanism.METHODS Forty ICR mice were randomly divided into 5 groups:normal control group (ig distilled water),model group (ig distilled water for 7 d,on the 7th day,ip cisplatin 25 mg·kg-1 to establish the model,afterwards ig distilled water for 3 d) and SVPr 5,10 and 20 mg· kg-1 groups (ig SVPr for 7 d,cisplatin 25 mg· kg-1 was provided 2 h after the last administration,then ig SVPr for 3 d).Testing kits were adopted for the measurement of renal indexes in mice,such as blood urea nitrogen (BUN) and serum creatinine (SCr);oxidative stress indictors of super oxide dismutase (SOD),catalase (CAT),glutathione (GSH) and malondialdehyde (MDA);inflammation indictor levels of tumor necrosis factor-α (TNF-α) and interleukin-6 (IL-6).Caspase 3,Bax and Bcl-2 were detected via Western blotting,and renal pathological changes were observed by HE staining.RESULTS SVPr (5,10 and 20 mg·kg-1) significantly reduced the levels of SCr,BUN,MDA,TNF-α and IL-6,and the expressions of caspase 3 and Bax (P＜0.05),but increased the activities of SOD,CAT and GSH,and the expression of Bcl-2 (P＜0.05).The renal pathological changes were improved.CONCLUSION SVPr can reduce renal toxicity induced by cisplatin in mice,and the mechanism is probably related to inhibiting oxidative stress or inflammatory reaction and improving cell apoptosis.

Postoperative acute kidney injury / 대한마취과학회지

Acute kidney injury (AKI) after cardiac surgery is a common and serious complication. Several definitions of AKI have been proposed recently, and include both increases in serum creatinine levels and decreases in urine output as diagnostic criteria. The pathophysiology of postoperative AKI is complex and involves both ischemic injury and systemic inflammation. Identifying risk factors, such as old age, underlying diabetes, heart failure, and obesity, may aid in the application of preventative methods for postoperative AKI. Additionally, recognizing different risks after different types of surgical procedures would be valuable. Novel biomarkers that could detect AKI more precisely at an earlier time point are being investigated. Several new biomarkers have been assessed in large multi-center studies and are believed to accommodate conventional clinical findings in diagnosing postoperative AKI. In high-risk patients, preventative measures, such as the maintenance of adequate hemodynamics and sufficient fluid resuscitation, could lower the incidence of postoperative AKI. Avoiding nephrotoxic agents and optimizing preoperative hemoglobin levels to avoid excessive transfusions would also be beneficial. In situations in which medical management fails to maintain sufficient urine output and acid–base and electrolyte homeostasis, early initiation of renal replacement therapy should be considered.

Long-term Follow-up Study on Valsartan and Amlodipine Tablets(Ⅰ)on Blood Pressure Control and Re-nal Protection of Patients with Refractory Hypertension / 中国药房

OBJECTIVE:To study the effect of long-term follow-up of Valsartan and amlodipine tablets(Ⅰ)on blood pressure control and renal protection of patients with refractory hypertension. METHODS:120 patients with refractory hypertension were di-vided into control group and observation group according to the patients’wishes,with 60 cases in each group. All patients accepted the triple therapy of amlodipine+valsartan+hydrochlorothiazide and life-style intervention;at the time of discharge from hospital, the blood pressure was well controlled. After discharge from hospital,control group was given amlodipine;observation group was given Valsartan and amlodipine tablet (Ⅰ) orally,1 tablet each time,qd,and dose increasing according to blood pressure,with maximal dose no more than 2 tablets. With 18 months of follow-up,blood pressure and renal function indexes of 2 groups were ob-served at different time points,and blood pressure control rate and the rate of renal function injury were also observed at the last follow-up;the occurrence of ADR was observed. RESULTS:2 cases and 3 cases were follow-up loss in observation group and con-trol group,respectively. With 12 and 18 months of follow-up,24 h systolic pressure,24 h diastolic pressure and 24 h urine protein of 2 groups increased significantly while creatinine clearance rate decreased significantly compared with before discharge;but the in-dexes of observation group was better than that of control group,with statistical significance(P0.05). CONCLUSIONS:Valsartan amlodipine tablet(Ⅰ)has obvi-ous advantages in long-term follow-up of blood pressure control of patients with refractory hypertension. It can significantly reduce the incidence of renal function injury with good safety.

Efeitos da lidocaína na proteção renal por meio da dosagem plasmática da NGAL e interleucinas: estudo em modelo experimental de lesão de isquemia e reperfusão em ratos / Effects of lidocaine in renal protection through the measurement of plasmatic NGAL and interleukim: study in an experimental, model of ischemia and reperfusion in rats

A lesão renal aguda isquêmica é um fenômeno comum em cirurgias de grande porte e em pacientes internados em unidades de tratamento intensivo. O restabelecimento do fluxo sanguíneo pode acarretar agravamento da lesão pelo mecanismo de isquemia e reperfusão (I/R). O objetivo deste estudo foi avaliar os efeitos protetores do emprego de doses diferenciadas de lidocaína em modelo experimental de I/R. Foram selecionados 40 ratos Wistar e divididos em quatro grupos aleatoriamente, sendo 10 animais por grupo. Grupo Lidocaína Dose Antiarrítmica - LDAA (equivalente à dose antiarrítmica em seres humanos), grupo Lidocaína Subdose – LSD (metade da dose do grupo anterior), grupo Controle - C (solução fisiológica) e grupo Sham - S. Com exceção do grupo Sham, os outros grupos foram submetidos à manobras de I/R no rim esquerdo. A nefrectomia direita foi realizada em um primeiro momento, antes das manobras no rim esquerdo. Os animais foram anestesiados com isoflurano. Avaliou-se os parâmetros: peso, frequência cardíaca (FC), pressão arterial sistólica (PAS), diastólica (PAD) e média (PAM) e temperatura no intraoperatório (T), dosagens plasmáticas de lidocaína, NGAL, IL-1α, IL-1β, IL-2, IL-4, IL-6, IL-10, IFN-γ, GM-CSF e TNF-α, nos momentos M0 (antes das manobras de I/R), M1 (após manobras de I/R) e M2 (24 horas após as manobras de I/R). Os rins direitos e esquerdos foram avaliados histologicamente. Os grupos foram uniformes quanto ao peso, temperatura e FC (> 250 bpm). Nos primeiros minutos do experimento a análise da PAS, PAD e PAM mostrou valores estatisticamente inferiores para os grupos LDAA e LSD. Detectou-se lidocaína no plasma dos animais, dos grupos LDAA e LSD, no M1 (2,9276 μg.mL-1 e 1,44 μg.mL-1)...

Ischemic acute kidney injury is a common phenomenon in large surgeries patients hospitalized in intensive care units. The restoration of blood flow can lead to the worsening of the injury by mechanism of ischemia and reperfusion (IR). The goal in this study was to evaluate possible protective effects in the use of lidocaine in an IR experimental model. 40 Wistar rats were selected and divided into 4 groups randomly, being it 10 rats per group. Lidocaine Arrhythmic Dose group – LDAA (equivalent to arrhythmic dose in humans), Lidocaine Subdose group – LSD (half of the previous group dose), Control group – C (saline solution) and Sham group – S. Except for the Sham group, the other groups experienced IR maneuver in the left kidney. The right nephrectomy was performed first, before the maneuver in the left kidney. The animals were anaesthetized with isoflurane. The following criteria were studied: weight, heart rate (HR), systolic blood pressure (SBP), diastolic blood pressure (DBP) and mean arterial pressure (MAP) and intra operative temperature. Plasma levels of lidocaine and: NGAL, IL-1α, IL-1β, IL-2, IL-4, IL-6, IL-10, IFN-γ, GM-CSF and TNF-α, in moments M0 (before IR maneuvers), M1 (after IR maneuvers) and M2 (24 hours after maneuvers). Right kidneys were histologically evaluated. Results: The groups were uniforms concerning weight, temperature and heart rate (> 250bpm). At the first minutes, the analysis of SBP, DBP and MAP displayed scores statistically lower for LDAA and LSD groups. Lidocaine was detected in animals plasma, in the LDAA and LSD groups, at M1 (2,9276 μg.ml-1 and 1,44 μg.ml-1)...

Los antagonistas de los receptores de la angiotensina II a la luz de los estudios de mayor impacto / Los antagonistas de los receptores de la angiotensina II a la luz de los estudios de mayor impacto

Introducción: Los antagonistas de los receptores de la angiotensina II constituyen un grupo reciente de fármacos para el tratamiento de la hipertensión arterial (HTA), su utilidad se ha extendido además al manejo de la Insuficiencia cardiaca, la nefroproteccion y el infarto agudo de miocardio. Farmacología: Actúan sobre el sistema renina-angiotensina-aldosterona aunque de diferente forma, bloqueando la unión de la angiotensina II a los receptores tipo 1 de la angiotensina II presentes en numerosos tejidos (tejido muscular liso, glándula adrenal y miocardio) y, como consecuencia, inhiben su efecto vasopresor y liberador de aldosterona. Conclusiones: En la hipertensión arterial. Son la alternativa a los inhibidores de la enzima conversora de la angiotensina (IECA) cuando sea necesario utilizar un antihipertensivo del eje renina-angiotensina y el paciente no pueda o no deba utilizar un fármaco de dicho subgrupo. Como nefroprotectores. Si bien los Antagonistas de los receptores de la Angiotensina (ARA II) han disminuido los niveles de proteinuria en pacientes renales siguen siendo una alternativa a los IECA. En la insuficiencia cardiaca. Los IECA son el tratamiento inicial, mientras que los ARA II pueden ser útiles en pacientes que no los toleren. En el post infarto agudo de miocardio. Los IECA siguen siendo el tratamiento de elección y los ARA II la alternativa cuando el paciente no tolere los IECA.

Introduction: Angiotensin-receptor blockers constitute a recent group of medicaments for the treatment in hypertension, its usefulness has spread in addition to the managing of the cardiac Insufficiency, renal protection and acute myocardial infarction. Pharmacology: Alter renin-angiotensin-aldosterone system though of different form, blocking the unión of angiotensin II to its receptors (type 1) in numerous organs (muscle, adrenal gland and myocardium) and, its consequence, disable its vasopresor effect and aldosterone liberating. Conclusions: In hypertension. Angiotensin-receptor blockers are alternative to angiotensine-converting-enzime inhibitors when it is necessary to use these antihypertensives and the patient could not or should not use a medicament of the above mentioned subgroup. In renal protection. Though Angiotensin-receptor blockers have diminished the levels of proteinuria in renalpatients continued being an alternative to angiotensine-converting-enzime inhibitors. In cardiac insufficiency. Angiotensine-converting-enzime inhibitors are initial treatment, whereas Angiotensin-receptor blockers can be usefulin patients who do not tolerate them. In post-acute myocardial infarction. Angiotensine-converting-enzime inhibitors continued being treatment of choice and the alternative when patients do not tolerate these medicaments.

Proteção renal na unidade de terapia intensiva cirúrgica: [revisão] / Renal protection in a surgical intensive care unit: [review]

JUSTIFICATIVA E OBJETIVOS: A disfunção renal peri-operatória é importante causa de aumento de morbimortalidade. Com o aumento da expectativa de vida, pacientes mais idosos e com maior números de co-morbidades estão sendo submetidos à procedimentos cirúrgicos de alto risco, o que torna as práticas da proteção orgânica possíveis modificadoras de prognóstico a curto e longo prazo. Nesse contexto, esta revisão sobre a proteção renal na unidade de terapia intensiva cirúrgica objetivou destacar os fatores de riscos peri-operatórios e discutir as atuais evidências científicas direcionadas para a diminuição da disfunção renal peri-operatória. CONTEÚDO: Apesar da baixa extração e adequada reserva renal de oxigênio, o rim é extremamente sensível à hipoperfusão sendo a insuficiência renal aguda uma complicação freqüente de instabilidade hemodinâmica. Este aparente paradoxo, comalto suprimento de oxigênio e reduzida extração, com alta incidência de lesão renal à hipotensão, é explicado pelo gradiente fisiológico intra-renal de oxigênio que torna a medula particularmente susceptível à isquemia. Identificou-se fatores de lesão renal em todas as fases do período peri-operatório: jejum e uso de contraste pré-operatório, hipovolemia, hipotensão, liberação de catecolaminas e citocinas, utilização e circulação extracorpórea, politrauma, presença de rabdomiólise e pinçamentoaórtico. É necessário que práticas capazes de diminuir a lesão renal peri-operatória sejam discutidas. CONCLUSÕES: O controle da lesão renal baseia-se nos princípios da fisiologia renal peri-operatória e na otimização da hemodinâmica glomerular. Medidas direcionadas para proteção orgânica devem ser implementadas devido ao impacto da insuficiência renal na evolução clínica neste grupo de pacientes.

BACKGROUND AND OBJECTIVES: Perioperative renal dysfunction is an important cause of morbidity and mortality. With increase of life expectancy, older patients with more co-morbidity are being submitted to high risk surgical procedures, what make clinical practice related to organ protection possible modifier of short and long term survival. This review about renal protection in surgical intensive care unit points risk factors and discusses scientific evidence related to reduction of renal dysfunction in perioperative. CONTENTS: Although low extraction and adequate renal reserve of oxygen, the kidney is extremely sensible to hypoperfusion being renal acute insufficiency a frequent complication of hemodynamic instability. This apparent paradox, high oxygen content and reduced extraction with high incidence of renal damage to hypotension reflects the intra-renal gradient of oxygen, what makes renal medulla highly susceptible to ischemia. Factors associated with renal lesion are observed in all fases of perioperative period: fasting, contrast use, hypovolemia, hypotension, catecholamine and cytokine release, extracorporeal circulation, trauma, rabdomiolisys and aortic clamp. CONCLUSIONS: Management of renal damage is based in principals of perioperative renal physiology and glomerular hemodynamic. Clinical practice directed to organic protection should be implemented to minimize the impact this dysfunction.

Protective effects of propofol on renal injury during liver ischemia-reperfusion / 中国康复理论与实践

@#ObjectiveTo investigate the remote renal injury after liver ischemia-reperfusion(I/R) and the renal protection afforded by propofol.Methods 72 male SD rats were randomly divided into three groups:normol control group, I/R group and propofol group .The animals were killed after 60 minutes ischemia of liver followed by reperfusion for 4 h,2 h. Blood urea nitrogen (BUN) and creatinine (Cr) were detected,and renal histopathologic lesion were observed.ResultsIn I/R group,the serum level of BUN and Cr increased significantly compared with the baseline before liver I/R,while propofol could decrease the serum level of BUN and Cr significantly.ConclusionPropofol can reduce the renal injury during liver I/R.

The Renal Effects of Furosemide Administration Followed by Unclamping of Supraceliac Aortic Cross Clamping in Experimental Dogs / 대한마취과학회지

BACKGROUND: The overall rate of renal complications after surgery on the suprarenal aorta remains high. Possible mechanisms are, a reduction and maldistribution of renal blood flow, activation of the renin-angiotensin system, and the release of various mediators. In this study, changes in renal blood flow, local renal perfusion, the oxygen extraction ratio, and in renal function by furosemide following supraceliac aortic cross clamping and unclamping were observed. METHODS: A total of 13 mongrel dogs were divided into two groups; a control group (n = 7), and a furosemide group (n = 6). For aortic cross clamping the supraceliac aorta was exposed and a doppler flowmeter probe was placed on the left renal artery. A thermal diffusion microprobe was also inserted in the renal parenchyme to measure local renal perfusion. Sixty minutes after aortic cross clamping, systemic hemodynamic data, renal blood flow, and local renal perfusion were measured. These parameters were also repeatedly measured at 1, 2, 3, 4, 5, and 6 hours after unclamping. Biomarkers of renal dysfunction and injury (renin activity, creatinine, and Cystatin-C) were measured. RESULTS: No differences were observed between the two groups in terms of renal blood flow, local renal perfusion, and oxygen extraction ratio. Renal blood flow and perfusion did not recover to the baseline level after unclamping in either group. Plasma renin activity significantly reduced in the furosemide group 3 hours after clamping, but serum creatinine, and Cystatin-C concentrations were similar in the tow groups. CONCLUSIONS: We conclude that the administration of furosemide after supraceliac aortic unclamping to improve renal function is not effective in experimental dogs.

Mechanism and preventive measures of renal injury after cardiopulmonary bypass / 医学研究生学报

Despite the continuous improvement of cardiopulmonary bypass(CPB),renal dysfunction remains a frequent complication of cardiac surgery.Previous studies reported that the incidence of acute renal dysfunction following CPB was 7%-40%,while that of acute renal failure(ARF) was 1%-10%.In those who developed ARF,the prognosis was poor,with mortality of about 40%-80%.The present paper reviews the mechanism,risks and available preventive measures of acute renal injury following CPB.

Effects on Renal Functions of Low Dose Dopamine in Partial Hepatectomy Patients / 대한마취과학회지

BACKGROUND: Low dose dopamine is widely used during the perioperative period to preserve renal perfusion. Low dose dopamine (3-5 microgram/kg/min) was administrated to partial hepatectomy patients and BUN, creatinine in serum were measured to determine the effects of low dose dopamine on renal function. METHODS: Liver group (n = 28) were administered low dose dopamine (3-5 microgram/kg/min) and the stomach group (n = 23) were not administered any vasoactive drugs during the operation. Perioperative plasma BUN, and creatinine, creatinine clearance, BUN/creatinine ratio, serum Na+ and K+, and central venous pressure (CVP) were checked 3 times, just after starting operation, 4 hours after starting the operation, and at PACU for both groups. We also evaluated intravascular volume status using the CVP and the BUN/creatinine ratio. Changes in BUN, and creatinine level during the operation in both group were compared. All the patients in this study were confirmed as having euvolemia by CVP and BUN/creatinine ratio. RESULTS: Urine volume increased significantly in the liver group with low dose dopamine compared to the stomach group (P < 0.05). The BUN level in the liver group increased significantly versus the stomach group (P < 0.05). In both groups, the creatinine level increased significantly (P < 0.05) and the plasma Na+ level decreased significantly (P < 0.05). CONCLUSIONS: We confirmed that low dose dopamine significantly increases urine volume in euvolemia status cases during liver surgery. But we were unable to determine why increased diuresis by the administration of low dose dopamine during operation and has a renal protective effect.