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Renal fibrosis， the final pathological outcome of end-stage chronic kidney diseases， is associated with inflammation， oxidative stress， epithelial-mesenchymal transdifferentiation （EMT）， and extracellular matrix deposition. It belongs to the categories of edema， ischuria， anuria and vomiting， and consumptive disease in traditional Chinese medicine （TCM）， with the key pathogenesis of Qi deficiency and blood stasis and the primary treatment principle of replenishing Qi and activating blood. Astragali Radix-Salviae Miltiorrhizae Radix et Rhizoma mainly contains astragalosides， polysaccharides， calycosin， salvianolic acid， and tanshinone， with the effect of tonifying Qi and activating blood. Studies have shown that this herb pair and its active components can delay the progress of renal fibrosis by regulating multiple signaling pathways. With consideration to the pathogenesis of Qi deficiency and blood stasis， this article reviews the research progress in the mitigation of renal fibrosis by Astragali Radix-Salviae Miltiorrhizae Radix et Rhizoma from the aspects of protecting glomerular filtration barrier， inhibiting EMT and mesangial cell proliferation， improving renal hemodynamics， and protecting renal function. Furthermore， the mechanisms were summarized. Specifically， Astragali Radix-Salviae Miltiorrhizae Radix et Rhizoma and its effective components can improve mitochondrial function and fatty acid metabolism， alleviate endoplasmic reticulum stress and autophagy disorders， and inhibit immune inflammation and oxidative stress by regulating nuclear factor E2-related factor 2 （Nrf2）/PTEN-induced kinase 1 （Pink1）， Nrf2/antioxidant response element （ARE）， tumor necrosis factor-α （TNF-α）/nuclear transcription factor-κB （NF-κB）， miR-21/Smad7/transforming growth factor beta （TGF-β）， Wnt/β-catenin， long non-coding RNA-taurine up-regulated gene 1 （lncRNA-TUG1）/tumor necrosis factor receptor-associated factor 5 （TRAF5）， Ras-related C3 botulinum toxin substrate 1 （Rac1）/cell division cycle protein 42 （CDC42）， Ras homolog （Rho）/Rho-associated coiled-coil containing protein kinase （ROCK）， phosphatidylinositol-3-kinase （PI3K）/protein kinase B （Akt）， Janus kinase （JAK）/signal transducer and activator of transcription （STAT）， peroxisome proliferator-activated receptor α （PPARα）/peroxisome proliferator-activated receptor γ coactivator l alpha （PGC-1α）， and p38 mitogen-activated protein kinase （p38 MAPK）. This review aims to provide references for the relevant research， give play to the role of Astragali Radix-Salviae Miltiorrhizae Radix et Rhizoma， and provide guidance for the clinical treatment of renal fibrosis.
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Objective::To observe the efficacy of modified Qiju Dihuang pills in protecting renal function of patients with early renal impairment with syndrome of Yin deficiency and Yang hyperactivity caused by hypertension and its effect in resisting inflammation and oxidative stress, and improving endothelial function. Method::Randomly divided into control group (59 cases) and observation group (60 cases) by random number table. Patients in control got valsartan capsules, 80 mg/time, 1 time/day. And patients whose blood pressure can't be controlled were added with nifedipine tablets, 10 mg/time, 1 time/day. In addition to the therapy of control group, patients in observation group were added with modified Qiju Dihuang pills, 1 dose/day. The control group took Qiju Dihuang pills.The courses of treatment were 16 weeks. And levels of cystatin C (CysC), urinary N-acetyl-β-glucosaminidase (NAG), β2 microglobulin (β2-MG), urinary microalbumin to creatinine ratio (UACR) and emodynamics of kidney were detected. Blood pressure, systolic pressure (SBP), diastolic pressure (DBP) and blood pressure renal artery resistance index (RI) and pulsatility index (PI) were recorded, and Yin deficiency and Yang hyperactivity were scored. Levels of nitric oxide (NO), endothelin-1 (ET-1), superoxide dismutase (SOD), glutathione peroxidase (GSH-Px), interleukin-6 (IL-6), tumor necrosis factor-alpha (TNF-α), adiponectin (ADPN) and nuclear factor-kappa B (NF-κB) were detected. Result::The total effective rate in observation group was 91.67%(55/60), which was higher than 76.27%(45/59) in control group (χ2=5.255, P<0.05). Levels of SBP and DBP were lower than those in control group (P<0.05). At the 16th week during the treatment, the compliance rate of blood pressure was 90.66%, which was higher than 84.13% in control group (χ2=127.65, P<0.01). And levels of CysC, β2-MG, NAG, UACR, RI, PI, ET-1, SOD, GSH-Px, IL-6, NF-κB and TNF-α were lower than those in control group (P<0.01), while levels of NO, SOD and GSH-Px were higher than those in control group (P<0.01). Conclusion::In addition to the therapy for controlling blood pressure with routine western medicine, modified Qiju Dihuang pills can reduce level of the blood pressure, and control blood pressure with the standard, with anti-inflammatory and anti-oxidative stress effects. It can also improve the vasomotor function and the flow of kidney, protect the kidney function, and reduce the degree of injury, so as to delay the process of kidney damage and improve the prognosis.
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OBJECTIVE: To evaluate the immediate effect of moxibustion at Shenshu (BL 23) on renal hemodynamics in patients with chronic kidney disease(CKD)．. METHODS: Thirty-two non-dialysis patients with CKD were recruited in this study. Moxibustion was applied at bilateral BL 23 for 30 min. The peak systolic velocity (PSV), end diastolic velocity (EDV) of the interlobar renal artery were measured by Doppler ultrasonography (US) before, and 0 and 15 min after moxibustion. The renal resistance index (RI) was equal to (PSV－EDV)/PSV. The body temperature (T), systolic blood pressure (SBP), diastolic blood pressure (DBP), heart rate (HR) were also monitored at the same time points. RESULTS: After moxibustion, the EVD level at 15 min after moxibustion was significantly increased (P0.05). CONCLUSION: Moxibustion at BL 23 can increase EDV and reduce renal RI of the interlobar renal artery in patients with CKD, which may be useful in relieving kidney disorders by improving renal blood flow.
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Lectins have been described as glycoproteins that reversibly and specifically bind to carbohydrates. Legume lectins isolated from the subtribe Diocleinae (Canavalia, Dioclea andCratylia) are structurally homologous with respect to their primary structures. The Diocleinae lectins of Canavalia brasiliensis, Dioclea guianensis andCanavalia ensiformis have been shown to distinctly alter physiological parameters in isolated rat kidneys. Thus, the aim of this study was to investigate the effect of Cratylia floribunda lectin (CFL) on renal hemodynamics and ion transport in rats. In isolated perfused kidneys, CFL (10 mg/mL, n=5) increased RPP, RVR and decreased %TK+, but did not change urinary flow, glomerular filtration rate, sodium or chloride tubular transport. In isolated perfused mesenteric bed, CFL (3 and 10 mg/mL/min; n=4) did not alter tissue basal tonus or tissue contraction by phenylephrine (1 mM/mL/min). In conclusion, the seed lectin of Cratylia floribunda increased renal hemodynamic parameters showing a kaliuretic effect. This effect could be of tubular origin, rather than a result from haemodynamic alterations.
As lectinas são descritas como (glico)proteínas que se ligam, especificamente e reversivelmente, a carboidratos. Lectinas de leguminosas isoladas da subtribo Diocleinae (Canavalia, Dioclea eCratylia) são estruturalmente homólogas em relação às suas estruturas primárias. Demonstrou-se que as lectinas de DiocleinaeCanavalia brasiliensis, Dioclea guianensis eCanavalia ensiformis alteram diferentemente parâmetros fisiológicos em rins isolados de ratos. Dessa maneira, o objetivo deste estudo foi investigar o papel da lectina de Cratylia floribunda (CFL) na hemodinâmica renal e no transporte de íons em ratos. Em rins isolados perfundidos, CFL (10 mg/mL, n=5) aumentou a pressão de perfusão renal, a resistência vascular renal e reduziu o percentual do transporte tubular de K+, mas não alterou o fluxo urinário, a taxa de filtração glomerular e o percentual de transporte tubular dos íons sódio e cloreto. No leito mesentérico isolado perfundido, CFL (3 e 10 mg/mL/min, n=4) não alterou o tônus basal ou a contração do tecido induzida por fenilefrina (1 mM/mL/min). Em conclusão, a lectina de sementes de Cratylia floribunda altera parâmetros hemodinâmicos renais, provavelmente de origem tubular, e não por alterações hemodinâmicas.
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Rats , Ion Transport , Plant Lectins/analysis , Dioclea , Hemodynamics , Amiloride/analysisABSTRACT
Objective To investigate the clinical implication value of using Doppler ultrasound to detect renal hemodynamic changes in children with Henoch-Schonlein purpura.Methods Color Doppler ultrasound was used to detect renal hemodynamic changes of main renal arteries and intedobar renal arteries and arcs renal arteries in 40 cases of Henoch-Schonlein purpura,whose urine routine,microalbuminuria were also tested,and 32 healthy children served as control group.Results Maximum crest flow rate (Vmax) during systole,minimum crest flow rate(Vmin) during diastole and resistance index(RI) of main renal arteries and interlobar renal arteries of children in HSP group were all higher than those of control group,while Vmax,Vmin and RI of arcs renal arteries were almost the same.Color doppler ullrasound showed that 28 cases were abnormal in renal flow,which accounted for 70％.Fourteen cases with abnormality were detected in routine urine and 18 cases in microalbuminutia,which accounted for 35％ and 45％ of total cases respectively.Sensitivity of color doppler ultrasound was higher than microalbuminuria and routine urine,while the sensitivity difference was not statistically different between microall uminuria and routine urine.Conclusions Renal hemodynamics is a sensitive index to find out renal lesion of early stages in children with Henoch-Schonlein purpura.
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Background: Many studies have reported the occurrence of lethal acute renal failure after snakebites. Bungarus candidus (Malayan krait) is a medically important venomous snake distributed widely throughout Southeast Asia. The best known features of systemic envenoming by B. candidus are neurotoxic. Objective: Obtain more information on effects of B. candidus venom on changes in systemic and renal hemodynamics in experimental animals. Methods: Twelve adult male New Zealand white rabbits were used to study the effect of B. candidus venom on general circulation and renal hemodynamics. An anesthetized animal was intravenously injected with B. candidus venom at a dosage of 50μg/kg bodyweight. All changes of parameters were observed after initial post venom injection and recorded at 30 min intervals until 150 minutes after envenomation. Results: After envenomation, cardiovascular responses showed a marked decrease in mean arterial pressure within two minutes, afterwards gradually returning closely to baseline values. There were stepwise decreases in heart rate and cardiac output, while total peripheral resistance was slightly increased. The renal hemodynamics significantly decreased by glomerular filtration rate, effective renal plasma flow and effective renal blood flow, while the filtration fraction significantly increased. Envenomed animals showed a reduction in renal fraction, while renal vascular resistance stepwise increased. The plasma potassium level tended to increase. Animals showed stepwise decreases in urinary excretion of Na+, K+ and Cl-. A marked decrease in plasma calcium level was apparent at 120 minutes, while plasma creatine phosphokinase and lactate dehydrogenase levels increased at 30-120 minutes. Conclusion: A significant drop in blood pressure was attributed to a sustained fall in cardiac output, which would be associated with a reduction in heart rate. Sustained hypotension would contribute to reduction of renal blood flow, which results in decreased GFR.
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Objective To investigate the relationship between the mutation of the exon 4 of leptin receptor gene(4Lys 109 Arg)and left ventricular function and renal hemodynamics in patients with hypertension.Methods From December 2005 to December 2006,digoxin marked primer enzyme coloration technique was used to detect the 4Lys 109 Arg polymorphism.The color Doppler echocardiography was used to detect the left ventricular function and the renal hemodynamics.The study covered 90 patients with hypertension (hypertension group)and 52 controls (control group).Results The frequencies of 4Lys109Arg in hypertension group and control group had no significant difference.The hypertension with GG genotype was significant difference in left ventrieular ejection fraction(LVEF),E/A,left ventrieular fractional shortening(LVFS),resistance index(BI),pulsatility index(PI)(P<0.05).The hypertension with GA genotype had significant difference in LVEF,E/A,LVFS(P<0.05).In hypertension group,LVEF,E/A,LVFS.RI and PI had significant difference between GG and AA genotype(P<0.05).In control goup,RI had significant difference between GG and AA genotype(0.65 ±0.02 vs 0.63±0.02,P<0.05).Conclusion The renal hemodynamics and the left ventricular function are associated with 4Lys109Arg polymorphism.
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A epidemia de obesidade que atinge a maioria dos países ocidentais é acompanhada por uma elevação alarmante no número de casos novos de doença renal crônica (DRC). A obesidade cursa com alterações hemodinâmicas renais caracterizadas por aumento do fluxo plasmático renal, hiperfiltração glomerulare retenção salina. A estas alterações, freqüentemente, se superpõem co-morbidades como o diabete melito e a hipertensão arterial, consideradasduas das causas mais freqüentes de DRC. Além disso, a obesidade pode acelerar a evolução de glomerulopatias preexistentes e pode induzir lesão renalde novo em pacientes uninefrectomizados. Finalmente, a obesidade tem sido associada a um tipo específico de lesão glomerular, manifesta por proteinúria,glomerulomegalia e esclerose glomerular segmentar e focal, o que também contribui para a gênese da DRC. No presente artigo, os autores d i s c u t em aspectos da interação entre obesidade e rim, bem como seu papel na indução e na progressão de nefropatias.
The worldwide epidemic of obesity has been associated with an alarming increase in the incidence of chronic kidney disease (CKD). Obesity courses with renal hemodynamic changes characterized by increased renal plasma flow, glomerular hyperfiltration and salt retention. Furthermore, obesity is associated with type 2 diabetes and hypertension, the two leading causes of CKD. Obesity can accelerate pre-existing glomerulopathy and is also implicated in the induction of renal disease de novo in patients subjected to unilateral nephrectomy. Finally, the obesity-related glomerulopathy, a clinical entity manifestedby proteinuria, glomerulomegaly and focal and segmental sclerosis, could also contribute to increase the prevalence of CKD. In this review, the authorsdiscuss the relationship between obesity and kidney as well as the role of obesity in inducing and worsening the outcome of nephropathies.
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Humans , Diabetes Complications , Kidney Failure, Chronic/etiology , Hemodynamics , Hypertension/complications , Obesity/complications , Obesity/epidemiologyABSTRACT
Objective To study the relationship between the renal hemodynamic changes and the course of the liver diseases and demonstrate weather the renal blood flow resistance index(RI)could be a useful index used to predict the hepatorenal syndrome(HRS)in the decompensated cirrhosis.Methods Select 41 patients diagnosed as decompensated cirrhosis from the patients examined by color Doppler ultrasonography at the Infectious Disease Department of Peking University First Hospital from April 2004 to July 2006.Test the serum creatinine,serum total bilirubin and INR,confirm the cause of the cirrhosis,and then calculate the MELD score.Detect by color Doppler ultrasonography to get RI.Results No correlation was found between RI and the patients's age,hemoglobin and systolic pressure.RI was found to be directly related with MELD score(r= 0.502,P
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Nitric oxide (NO) is synthesized within the adult and developing kidney and plays a critical role in the regulation of renal hemodynamics and tubule function. In the adult kidney, the regulation of NO synthesis is very cell type specific and subject to distinct control mechanisms of NO synthase (NOS) isoforms. Endothelial NOS (eNOS) is expressed in the endothelial cells of glomeruli, peritubular capillaries, and vascular bundles. Neuronal NOS (nNOS) is expressed in the tubular epithelial cells of the macula densa and inner medullary collecting duct. Furthermore, in the immature kidney, the expression of eNOS and nNOS shows unique patterns distinct from that is observed in the adult. This review will summarize the localization and presumable function of NOS isoforms in the adult and developing kidney.
Subject(s)
Adult , Humans , Capillaries , Endothelial Cells , Epithelial Cells , Hemodynamics , Kidney , Neurons , Nitric Oxide Synthase , Nitric Oxide , Protein IsoformsABSTRACT
Between August 1993 and Apri1 1994, intrarenal arterial color duplex Doppler sonography was performed on 55 patients(110 kidneys) with acute ureteral obstruction and 12 patients(24 kidneys) with painless ureteral obstruction by unilateral ureteral stones to assess renal hemodynamic changes and its clinical applications. The mean resistive index(RI) of the doppler waveforms obtained on the acutely obstructed 55 kidneys(0.663+/-0.055) was significantly higher than that of the contralateral normal kidneys (0.613+/-0.052) (P0.05). There was no correlation between the levels of ureteral obstruction and intrarenal RI values(P>0.05). The RIs of 3 significantly obstructed kidneys decreased after relief of obstruction. We conclude that the RI is easily obtained and measured, and it would provide important physiological informations on renal vascular impedance in acute ureteral obstruction. Renal doppler findings could be the one of the criteria for assessing the upper urinary tract obstruction.
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Humans , Electric Impedance , Hemodynamics , Kidney , Ultrasonography, Doppler , Ureter , Ureteral Obstruction , Urinary TractABSTRACT
To comparative study the effect of polysaccharide sulfate (PSS) and amlodipine on renal hemodynamics in dogs. The kidney was denervated, PSS or amlodipine was injected through renal artery. Renal hemodynamic parameters, including mean arterial pressure, renal blood flow, glomerular filtration, urine flow, et al, were measured. Both PSS and amlodipine significantly increased renal blood flow and urine flow (P