ABSTRACT
With the gradual aggravation of aging in China， the prevalence of osteoporosis is increasing year by year. Osteoporosis has become a major public health problem threatening the health of middle-aged and elderly people， especially middle-aged and elderly women. There are many predisposing factors and complex pathogenesis of osteoporosis. The interpretation of osteoporosis has been the focus of clinical research in recent years. How to prevent and treat osteoporosis more effectively has also become a major problem faced by researchers. In recent years， the balance and homeostasis of calcium and phosphorus regulated by intestinal absorption， renal excretion and bone have become one of the hot topics， and the balance and homeostasis of calcium and phosphorus in vivo are the key to normal bone homeostasis. At the same time， as a complex microbial community living in the gastrointestinal tract， intestinal flora can produce a variety of regulators affecting metabolism. It has been widely confirmed that it acts on the body indirectly or directly， in multiple ways and targets to prevent and treat osteoporosis. Therefore， further exploring the role and mechanism of intestine kidney bone axis in osteoporosis plays a far-reaching significance for the prevention and treatment of osteoporosis. In recent years， scholars have made a lot of exploration on the prevention and treatment of osteoporosis with traditional Chinese medicine （TCM）， and found that TCM can intervene the expression of intestinal flora and play the effect of prevention and treatment of osteoporosis. Based on the "intestine kidney bone axis"， this paper briefly discusses the integrated traditional Chinese and western medicine of kidney and osteoporosis， intestine and osteoporosis， intestine kidney axis， the treatment of kidney from intestine， intestine and osteoporosis， and the application of TCM in regulating intestinal flora in osteoporosis， in order to provide new ideas for the prevention and treatment of osteoporosis.
ABSTRACT
With the gradual aggravation of aging in China， the prevalence of osteoporosis is increasing year by year. Osteoporosis has become a major public health problem threatening the health of middle-aged and elderly people， especially middle-aged and elderly women. There are many predisposing factors and complex pathogenesis of osteoporosis. The interpretation of osteoporosis has been the focus of clinical research in recent years. How to prevent and treat osteoporosis more effectively has also become a major problem faced by researchers. In recent years， the balance and homeostasis of calcium and phosphorus regulated by intestinal absorption， renal excretion and bone have become one of the hot topics， and the balance and homeostasis of calcium and phosphorus in vivo are the key to normal bone homeostasis. At the same time， as a complex microbial community living in the gastrointestinal tract， intestinal flora can produce a variety of regulators affecting metabolism. It has been widely confirmed that it acts on the body indirectly or directly， in multiple ways and targets to prevent and treat osteoporosis. Therefore， further exploring the role and mechanism of intestine kidney bone axis in osteoporosis plays a far-reaching significance for the prevention and treatment of osteoporosis. In recent years， scholars have made a lot of exploration on the prevention and treatment of osteoporosis with traditional Chinese medicine （TCM）， and found that TCM can intervene the expression of intestinal flora and play the effect of prevention and treatment of osteoporosis. Based on the "intestine kidney bone axis"， this paper briefly discusses the integrated traditional Chinese and western medicine of kidney and osteoporosis， intestine and osteoporosis， intestine kidney axis， the treatment of kidney from intestine， intestine and osteoporosis， and the application of TCM in regulating intestinal flora in osteoporosis， in order to provide new ideas for the prevention and treatment of osteoporosis.
ABSTRACT
Objective:To observe the effects of modified Liuwei Dihuangtang on serum fibroblast growth factor 23 （FGF23）， full-length intact parathyroid hormone （iPTH）， and 1，25-dihydroxyvitamin D<sub>3 </sub>［1，25（OH）<sub>2</sub>D<sub>3</sub>］ levels and Klotho and FGF23 protein expression in renal and bone tissues of rats exposed to high phosphorus combined with adenine， so as to explore the mechanism of modified Liuwei Dihuangtang against renal osteopathy. Method:One hundred and thirty healthy adult SD rats were randomly divided into five groups， namely normal group（<italic>n</italic>=10），high phosphorus group（<italic>n</italic>=30），model group（<italic>n</italic>=30），modified Liuwei Dihuangtang group（<italic>n</italic>=30） ， and calcitriol group（<italic>n</italic>=30），and rats in each group were further classified based on three time points， namely 8，10， and 12 weeks. Rats in the normal group were fed with normal diet， the ones in the high phosphorus group with high phosphorus diet， and those in the other groups with adenine and high phosphorus diet for inducing renal osteopathy. Rats in the normal group，high phosphorus group， and model group were intragastrically administered with distilled water （10 mL·kg<sup>-1</sup>·d<sup>-1</sup>），the ones in the modified Liuwei Dihuangtang group with modified Liuwei Dihuangtang （2.556 g·kg<sup>-1</sup>·d<sup>-1</sup>） ， and those in the calcitriol group with calcitriol （0.09 μg·kg<sup>-1</sup>·d<sup>-1</sup>）. Result:Compared with the normal group and high phosphorus group at the weeks of 8，10 and 12，the model group displayed significantly elevated blood urea nitrogen（BUN），serum creatinine（SCr），serum phosphorus，iPTH，FGF23，renal interstitial fibrosis score， and FGF23 expression in renal and bone tissues， but lowered serum calcium and 1，25（OH）<sub>2</sub>D<sub>3</sub> and Klotho protein expression in renal and bone tissues（<italic>P</italic><0.05 ，<italic>P</italic><0.01）. Compared with the model group at the weeks of 8，10 and 12， the modified Liuwei Dihuangtang and calcitriol both significantly decreased the serum BUN，SCr，serum phosphorus，iPTH， FGF23， tubulointerstitial semi-quantitative score， and FGF23 expression in renal and bone tissues， while increased the serum calcium，1，25（OH）<sub>2</sub>D<sub>3</sub>， and Klotho protein expression in renal and bone tissues （<italic>P</italic><0.05，<italic>P</italic><0.01）. There was no significant difference in the above-mentioned indexes between the modified Liuwei Dihuangtang group and the calcitriol group at the same time point. Conclusion:Klotho-FGF23 axis is probably involved in renal osteopathy. The modified Liuwei Dihuangtang effectively improves renal function，alleviates pathological changes in renal and bone tissues，and regulates calcium and phosphorus metabolism to protect the bone， which is related to its regulation of Klotho-FGF23 axis.
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LI Dong-yuan discussed the pathogenesis and treatment of "atrophic debility of bones" in his writings. This article explained and summarized the pathogenesis of atrophic debility of bones in LI's works. LI held that the pathogenesis of atrophic debility of bones is divided into damp-heat, overabundant yin leading to yang hyperactivity, and overabundant yin leading to insufficient yang. Combined with clinical observation, this article considered that the LI's atrophic debility of bones is similar to renal osteopathy in terms of disease name, clinical manifestation and pathogenesis. Therefore it put forward to the treatment of renal osteodystrophy from LI's theory. The methods of treatment were invigorating splenic yang and dehumidify, moistening dryness and tonifying kidney, replenishing qi, purging yin fire, raising yang and lifting prolapsed zang-fu organs, and expeling wind and removing dampness.
ABSTRACT
LI Dong-yuan discussed the pathogenesis and treatment of "atrophic debility of bones" in his writings. This article explained and summarized the pathogenesis of atrophic debility of bones in LI's works. LI held that the pathogenesis of atrophic debility of bones is divided into damp-heat, overabundant yin leading to yang hyperactivity, and overabundant yin leading to insufficient yang. Combined with clinical observation, this article considered that the LI's atrophic debility of bones is similar to renal osteopathy in terms of disease name, clinical manifestation and pathogenesis. Therefore it put forward to the treatment of renal osteodystrophy from LI's theory. The methods of treatment were invigorating splenic yang and dehumidify, moistening dryness and tonifying kidney, replenishing qi, purging yin fire, raising yang and lifting prolapsed zang-fu organs, and expeling wind and removing dampness.
ABSTRACT
Objective To explore the therapeutic effect and nursing points of different linked modes in hemodialysis combined with hemoperfusion on renal osteopathy disease in maintenance hemodialysis (MHD) patients.Methods Sixty-four MHD patients with renal osteopathy disease were enrolled in the study.They were divided into two groups by random digits table method:the front connection group and the back connection group with 32 cases each.Their clinical data,serum parameters and complications were recorded.The therapeutic effect of two groups were compared.Results The serum level of intact parathyroid hormone(iPTH) was (191.36 ± 53.96) ng/L in the front connection group,while (133.02 ± 38.63) ng/L in the back connection group,and there was significant difference,t=3.517,P＜0.05.The incidence of lower blood pressure and blood coagulation were 8.85％(51/576),6.94％(40/576) in the back connection group,while 14.93％(86/576),15.97％(92/576) in the front connection group,and there were significant differences,x2=10.149,23.136,P＜0.01.Conclusion The back linked mode in hemodialysis combined with hemoperfusion can obviously decrease iP:TH of MHD patients combined with renal osteopathy disease and has less complications,worth clinical promotion.
ABSTRACT
The damage of chronic kidney disease-mineral and bone disorder (CKD-MBD) has drawn increasing attention in recent years. In addition to traditional pathogenic factors, energy regulatory factors such as leptin, insulin, and adiponectin also participate in the development and progression of CKD-MBD. Hyperleptinaemia can directly or indirectly affect bone formation. CKD patientswith diabetes have injured osteoblast function and are liable to have low dynamic osteopathy with low parathyroid hormone (PTH). Adiponectin is increased in CKD patients, which can be used as a marker forseverity of osteopathy. More basic and clinical researches are needed to elucidate the mutual influence between CKD-MBD and energy metabolism. The interventions targeting molecular mechanisms may bring new treatments to CKD-MBD. This paper reviewed the mutual influence of CKD-MBD and energy metabolism.
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Objective To explore therapeutic effects of combinative artificial kidney treatment on renal osteopathy.Methods HD + HP Group composed by 30 urinaemia was treated with hemodialysis and hemoperfusion,and the HD Group was treated only with hemodialysis.Clinical symptoms and lab indicators including osteodynia,itch of skin,blood pressure,appetite,sleep,as well as BUN,SCr,Hb,BPC,Ca,P and iPTH,were compared between the two groups.Results Osteodynia decreased by 67.7% (21/31),and itch of skin by 71.0% (22/31)in HD group.Osteodynia decreased by 96.7% (29/30) ,and itch of skin by 96.7% (29/30) in HD + HP group (P ＜0.01 ).iPTH were (65.5 ± 34.4) pmol/L before treatment and (57.1 ± 21.4) pmol/L after treatment in HD group,and (73.5 ± 44.4)pmol/L and (19.1 ± 17.4)pmol/L in HD + HP group.HD Group eliminated less iPTH (P ＞0.05).HD + HP Group removed more serum poison molecules than HD Group ( P ＜ 0.05 ).Conclusions For patients in maintenance-dialysis stage but with higher iPTH,hemodialysis combined with hemoperfusion removes more poison molecules,consequently decreases incidence of renal osteopathy.
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Objective To observe the clinical effect of resin adsorbing devices combined with hemodialysis in the treatment for renal osteopathy in chronic renal failure patients undergoing maintenance hemodialysis.Methods Fifty two patients undergoing maintenance hemodialysis for at least 2 years,admitted from January 2004 to October 2006,were divided into three groups:group A,resin adsorbing devices combined with hemodialysis group(HP+HD);group B,hemodiafiltration group(HDF+HD);group C,active vitamin D peroral group(Oral vitamin D+HD).The changes in serum parathyroid hormone(iPTH)and phosphorus,urea nitrogen(BUN),creatinine(SCr),hemoglobin(Hb)were compared among the three groups before and after the treatment.Results No significant difference was found in BUN,SCr,and Hb contents among the three groups before and after the treatment.Compared with the data before the treatment,iPTH and phosphorus were decreased significantly after 12 weeks of treatment in group A(P