Therapeutic Role of Tangshenkang Granule () in Rat Model with Diabetic Nephropathy.

OBJECTIVE: To evaluate the renal protective effect of Tangshenkang Granule () in a rat model of diabetic nephropathy (DN). METHODS: Forty male Sprague-Dawley rats were randomly divided into control, DN, Tangshenkang and benazepril groups. DN model was established in the rats of DN, Tangshenkang and benazepril groups. Tangshenkang Granule solution and benazepril hydrochloride solution were intragastrically administered daily to the rats in the Tangshenkang and benazepril groups for 8 weeks, respectively. Urinary albumin and creatinine were detected. The albumin/creatinine (ACR) was calculated in addition to 24 h urinary protein (24-h UPr), serum creatinine (Scr), blood urea nitrogen (BUN), total cholesterol (TC), triglyceride (TG), low-density lipoprotein (LDL), high-density lipoprotein (HDL), and creatinine clearance rate (Ccr). Right kidneys were harvested for pathological observation using periodic acid-silver methenamine-Masson staining. The average glomerular diameter (DG), average glomerular (AG) and mesangial areas (AM) were measured. The thickness of glomerular basement membrane (TGBM) was detected using transmission electron microscope. RESULTS: Compared with rats in the control group, rats in the DN group showed significantly decreased body weight, increased hypertrophy index, 24-h urinary volume, 24-h UPr, ACR, Scr, BUN, Ccr, blood lipids as well as renal pathological indices including DG, AG, AM, AM/AG and TGBM (P <0.05). Compared with the DN group, the weights of rats in the Tangshenkang and benazepril groups were significantly increased, and the renal hypertrophy indices were significantly decreased (P <0.05). The 24-h urinary volumes, ACR, 24-h UPr, Scr, BUN, Ccr, LDL, DG, AG, AM and TGBM were obviously decreased (P <0.05). Compared with the benazepril group, the Tangshenkang group showed significantly decreased levels of ACR, 24-h UPr, AG and AM (P <0.05). CONCLUSIONS: Tangshenkang Granule decreased the urinary protein, attenuated the high glomerular filtration rate and improved lipid metabolism in DN rats, and prevented further injury induced by diabetic nephropathy.

[Intervention of Qingshen Granule on NF-KB Signal Pathway of Chronic Renal Failure Patients with Damp-heat Syndrome].

Objective To observe the effect of Qingshen Granule (QG) on expressions of nucle- ar factors-κB p65 (NF-κB p65) and phosphonated inhibitor of nuclear factor-κB (p-lκBα) in peripheral blood NF-κB signal transduction pathway of chronic renal failure (CRF) patients with damp-heat syn- drome (DHS) , and to study possible mechanism. Methods Totally 68 CRF patients with DHS were as- signed to the control group and the treatment group by random digit table, 34 in each group. Actually 63 patients completed, 32 in the treatment group and 31 in the control group. A normal group (20 cases) was set up. All patients received basic treatment of Western medicine (WM) and retention enema of Chi- nese medicine (CM). Patients in the treatment group additionally took QG, 1 package each time, 3 times per day. The therapeutic course for all was 8 weeks. The clinical efficacy, level of serum creatinine (SCr), estimated glomerular filtration rate (eGFR), the levels of NF-κB p65 and p-IκBα in peripheral blood were observed and measured before and after treatment. They were also compared with those of the normal group. Results The clinical efficacy and the total effective rate of CM syndrome were 84. 38% (27/32)and 81. 25% (26/32), superior to those of the control group [54. 84%(17/31), 51. 61% (1631) ; P <0. 01 ]. Compared with before treatment, the level of SCr was obviously lower, and eGFR was obviously higher in the treatment group after treatment (P <0. 01). They were better than those of the control group after treatment (P <0. 05). Compared with the normal group, the levels of NF-κB p65 and p-IκBα were significantly higher in the treatment group and the control group before treatment (P < 0. 01). Compared with before treatment, the levels of NF-κB p65 and p-IκBα were obviously lowered in the treatment group after treatment (P <0. 01). They were also better than those of the control group after treatment (P <0. 05). Conclusions QG could improve clinical symptoms of CRF patients with DHS, de- crease SCr level, and increase eGFR level. It could protect renal function. Its mechanism might possibly be related with reducing peripheral blood levels of NF-κB p65 and p-IκBα.

[Intervention of Qingshen Granule for Immune Inflammation of Chronic Renal Failure Patients with Damp-heat Syndrome].

Objective To observe the effect of Qingshen Granule (QG) on the immune function of chronic renal failure (CRF) patients with damp-heat syndrome (DHS). Methods A total of 162 CRF patients were assigned to the treated group and the control group by random digit table, 81 in each group. All patients were treated with conventional Western medical therapy. Those in the treated group addition- ally took QG, one package each time (10 g) , thrice per day. The therapeutic course for all was 12 weeks. The clinical efficacy was observed in the two groups. The contents of peripheral blood CD4 ⁺ T cells, CD8 ⁺ T cells, Thl7 cells, and nuclear factor-κB p65 (NF-κBp65) activity were detected using flow cy- tometry. Expressions of serum IL-17, tumor necrosis factor receptor-associated factor 6 (TRAF6), ma- trix metalloproteinase-9 (MMP-9) , matrix metalloproteinase inhibitor-I (TIMP-1 ) , collagen N (Col-V) were detected using ELISA. Results Finally 156 patients completed the trial (77 cases in the treated group and 79 cases in the control group). The total clinical curative effective rate was significantly higher in the treated group (80. 52%, 62/77) than in the control group (68. 35%, 54/79) with statistical differ- ences between the two groups (x² = 54. 849, P <0. 05). Compared with before treatment in the same group, the levels of peripheral blood CD4 ⁺ /CD8 ⁺ , Thl7 cell content, NF-κB p65 activity, serum levels of IL-17, TRAF6, and TIMP-1 , TIMP-1/MMP-9 ratio, Col-IV level all decreased in the treated group after treat- ment (P <0. 05) ; serum MMP-9 level decreased .(P <0. 05) and TIMP-1 /MMP-9 ratio increased (P <0. 05) in the control group. Compared with the control group, CD4⁺/CD8 ⁺ T cell ratio, Th17 cell content, NF-κB p65 activity decreased more obviously in the treated group after treatment (P <0. 05). Serum levels of IL- 17, TRAF6, TIMP-1, TIMP-1/MMP-9 ratio, and Col-IV all decreased (P <0.05) and MMP-9 level increased (P <0. 05) in the treated group (P <0. 05). Conclusion QG could adjust immune dysfunction and disar- ranged immunity mediated inflammatory response, and attenuate renal fibrosis in CKD patients with DHS.

[Effects of Qingshen Granule on serum interleukin-8 and -18 levels in patients with a sharp deterioration of chronic renal failure and dampness-heat syndrome: a randomized controlled trial].

BACKGROUND: Dampness-heat syndrome is a major syndrome type in patients with a sharp deterioration of chronic renal failure (CRF). Qingshen Decoction, a compound traditional Chinese herbal medicine, could relieve the clinical symptoms of CRF patients, and was considered to have a certain reversal effect on rapid deterioration of renal function. OBJECTIVE: To observe the changes of serum interleukin-8 (IL-8) and IL-18 levels in CRF patients with a sharp deterioration and dampness-heat syndrome, and to explore the curative efficacy of Qingshen Granule. DESIGN, SETTING, PARTICIPANTS AND INTERVENTIONS: Sixty CRF patients with a sharp deterioration and dampness-heat syndrome from Department of Nephrology, the First Affiliated Hospital of Anhui College of Traditional Chinese Medicine, were randomly divided into treatment group (30 cases) and control group (30 cases), with another 20 healthy individuals as normal control. The patients in the treatment and control groups were all treated with Jiedu Xiezhuo II, a compound traditional Chinese herbal medicine, given as retention enema. Qingshen Granule was additionally administered to the patients in the treatment group with 1 dosage each time and 3 times a day. The treatment course was one month. MAIN OUTCOME MEASURES: The levels of serum IL-8 and IL-18 in the normal individuals and before and after treatment in the treatment and control groups were detected. RESULTS: The total response rates of treatment group in clinical efficacy assessment and assessment of syndrome of traditional Chinese medicine (86.67% and 86.67%) were higher than those of the control group (56.67% and 60%), and there were significant differences between the two groups (P<0.05). The levels of serum IL-8 and IL-18 in CRF patients before treatment were obviously higher than those in the healthy individuals (P<0.01), and there were no differences in the levels of IL-8 and IL-18 before treatment between the treatment group and control group (P>0.05). After one-month treatment, the levels of serum IL-8 and IL-18 were markedly decreased in the two groups (P<0.01), and the levels of serum IL-8 and IL-18 in the treatment group were markedly lower than those in the control group (P<0.05). There were differences in decreased degrees of IL-8 and IL-18 levels between the two groups (P<0.05). CONCLUSION: CRF patients with a sharp deterioration and dampness-heat syndrome have high serum IL-8 and IL-18 levels. Qingshen Granule can reduce the levels of serum IL-8 and IL-18, and improve the renal function and ameliorate the clinical symptoms.

[Intervention of liuwei dihuang pill on lupus nephropathy treated with cylophosphamide and glucocorticoids].

OBJECTIVE: To investigate the intervening effect of Liuwei Dihuang pill (LWDH) on lupus nephropathy (LN) treated with glucocorticoids and cyclophosphamide (CTX). METHODS: Sixty-four patients were randomly divided into two groups, all patients were treated by conventional treatment, using prednisone in standard program, and CTX in a daily dose of 8 - 12 mg/kg, accumulated dose < or = 150 mg/kg, by adding into 500 ml of 5% glucose in saline through intravenous dripping, as well as the symptomatic treatment. Patients in the treated group were given LWDH additionally. RESULTS: The curative effect in the treated group was significantly superior to that in the control group (P < 0.05). Laboratory indexes, including urinary protein, plasma protein and serum creatinine (SCr), erythrocyte sedimentation rate (ESR), complement C3, etc. were significantly improved in both groups (P < 0.01), but all the improvement, except that of SCr, in the treated group were superior to those in the control group respectively (P <0.05 or P <0.01). Besides, the recurrent rate and incidence rate of adverse reaction in the treated group was significant lower than those in the control group (P < 0.05 and P < 0.01). CONCLUSION: LWDH can significantly enhance the therapeutic effect of CTX and glucocorticoids on LN, decrease the recurrence and shows advantage in counteracting against the adverse effects of glucocorticoids and CTX.

[Clinical study on intervention of liuwei dihuang pill on hormonotherapy in treating nephrotic syndrome].

OBJECTIVE: To observe the intervention of liuwei dihuang pill (LDP) on therapeutic effectiveness and adverse reaction of hormonotherapy in treating nephrotic syndrome. METHODS: Patients allocated in two groups were medicated with initial dose of prednisone 1 mg/kg once a day at 8 am in the morning. After being medicated for 8 to 12 weeks, the dose of prednisone was decreased by 5.0 mg every 2 weeks till 0.5 mg/kg per day. Then the medication was changed to that two days' dosage orally take once a day with the daily dose reduced by 5.0 mg/kg every 2 to 3 weeks, and maintained at 0.4 mg/kg once every two days. At same time, necessary symptomatic treatment was given. To the treated group oral administration of LDP 8 capsules was given additionally, 3 times per day until prednisone decreased to maintenance dose. RESULTS: Therapeutic effect in the treated group was significant better than that in the control group (P < 0.05). Urinary protein, plasma albumin, triglyceride (TG) and total cholesterol (TC) in both groups were obviously improved (P < 0.05 or P < 0.01). However, as compared with the control group, the improvement was better, and the recurrent rate was lower (P < 0.05) in the treated group. Scores of Yin-deficiency caused excessive Fire syndrome and incidence rate of adverse reaction in the treated group were lower than those in the control group (P < 0.05 or P < 0.01). CONCLUSION: LDP can markedly improve the therapeutic effectiveness and counteract the adverse reaction of hormonotherapy in treating nephrotic syndrome, and reduce the recurrence of the disease.