Radix Astragali (a Chinese medicinal herb) for treating chronic kidney disease

JiaWeiDangGui Decoction Ameliorates Proteinuria and Kidney Injury in Adriamycin-Induced Rat by Blockade of TGF-β/Smad Signaling

JiaWeiDangGui (JWDG) decoction has anti-inflammatory and antifibrotic effects, which is used widely for the treatment of various kidney diseases. In previous studies, we have found that JWDG decoction can reduce the quantity of proteinuria, but the mechanism was unknown. Here, we studied the protective effect of JWDG decoction in adriamycin-induced nephropathy on rat. JWDG decoction, at 10 mL/kg/d, 20 mL/kg/d, and 40 mL/kg/d, was orally administered daily for 12 weeks. Therapeutic effects and mechanisms were further examined. The kidney function related biochemical indexes were measured by automatic biochemistry analyzer. The pathomorphological changes were observed using light and transmission electron microcopies. The proteins expressions of podocin, nephrin, collagen IV, and fibronectin (FN) were examined by immunohistochemical staining, and key proteins involved in TGF-β/Smad signaling were evaluated by RT-PCR and western blotting. Compared with vehicle-treated controls, JWDG decoction decreased the quantity of proteinuria; reduced glomerulosclerotic lesions induced by ADR; and preserved the expression of podocin and nephrin. JWDG decoction also inhibited the expression of the collagen IV, FN, and fibrogenic TGF-β. Further studies revealed that inhibition of renal fibrosis was associated with the blockade of TGF-β/Smad signaling and downregulation of snail expression dose dependently. JWDG decoction prevents proteinuria production, podocyte dysfunction, and kidney injury in adriamycin nephropathy by inhibiting TGF-β/Smad signaling.

Astragalus (a traditional Chinese medicine) for treating chronic kidney disease

BACKGROUND

Astragalus (Radix Astragali, huang qi) is the dried root of Astragalus membranaceus (Fisch.) Bge. var. mongholicus (Bge.) Hsiao or Astragalus membranaceus (Fisch.) Bge. (Family Leguminosae). It is one of the most widely used herbs in traditional Chinese medicine for treating kidney diseases. Evidence is needed to help clinicians and patients make judgments about its use for managing chronic kidney disease (CKD).

OBJECTIVES

This review evaluated the benefits and potential harms of Astragalus for the treatment of people with CKD.

SEARCH METHODS

We searched the Cochrane Renal Group's Specialised Register to 10 July 2014 through contact with the Trials' Search Co-ordinator using search terms relevant to this review. We also searched CINAHL, AMED, Current Controlled Trials, OpenSIGLE, and Chinese databases including CBM, CMCC, TCMLARS, Chinese Dissertation Database, CMAC and Index to Chinese Periodical Literature.

SELECTION CRITERIA

Randomised controlled trials (RCTs) and quasi-RCTs comparing Astragalus, used alone as a crude herb or an extract, with placebo, no treatment, or conventional interventions were eligible for inclusion.

DATA COLLECTION AND ANALYSIS

Two authors independently extracted data and assessed risk of bias in the included studies. Meta-analyses were performed using relative risk (RR) for dichotomous outcomes and mean differences (MD) for continuous outcomes, with 95% confidence intervals (CI).

MAIN RESULTS

We included 22 studies that involved 1323 participants, of whom 241 were receiving dialysis treatment. Risk of bias was assessed as high in six studies, and unclear in the remaining 16 studies. Study quality was low overall.Our nominated primary outcomes of time to requirement for renal replacement therapy (RRT) or initiation of dialysis and all-cause mortality were not reported in any of the included studies.Results concerning the effects of Astragalus on kidney function were inconsistent. Astragalus significantly increased CrCl at end of treatment (4 studies, 306 participants: MD 5.75 mL/min, 95% CI 3.16 to 8.34; I² = 0%), decreased SCr (13 studies, 775 participants: MD -21.39 µmol/L, 95% CI -34.78 to -8; I² = 70%) and especially in those whose baseline SCr was < 133 µmol/L in particular (3 studies, 187 participants: MD -2.52 µmol/l, 95% CI -8.47 to 3.42; I² = 0%). Astragalus significantly decreased 24 hour proteinuria at end of treatment (10 studies, 640 participants; MD -0.53 g/24 h, 95% CI -0.79 to -0.26; I² = 90%); significantly increased haemoglobin levels overall (4 studies, 222 participants): MD 9.51 g/L, 95% CI 4.90 to 14.11; I² = 0%) and in haemodialysis patients in particular (3 studies, 142 participants: MD 11.20 g/L, 95% CI 5.81 to 16.59; I² = 0%). Astragalus significantly increased serum albumin (9 studies, 522 participants: MD 3.55 g/L, 95% CI 2.33 to 4.78; I² = 65%). This significant increase was seen in both dialysis (3 studies, 152 participants): MD 4.04 g/L, 95% CI 1.91 to 6.16; I² = 72%) and non-dialysis patients (6 studies, 370 participants: MD 3.24 g/L, 95% CI 1.70 to 4.77; I² = 61%). Astragalus significantly decreased systolic blood pressure (2 studies, 77 participants: MD -16.65 mm Hg, 95% CI -28.83 to -4.47; I² = 50%), and diastolic blood pressure (2 studies, 77 participants: MD -6.02 mm Hg, 95% CI -10.59 to -1.46; I² = 0%).Six of 22 included studies reported no adverse effects were observed; while the remaining 16 studies did not report adverse effects.

AUTHORS' CONCLUSIONS

Although Astragalus as an adjunctive treatment to conventional therapies was found to offer some promising effects in reducing proteinuria and increasing haemoglobin and serum albumin, suboptimal methodological quality and poor reporting meant that definitive conclusions could not be made based on available evidence.