OBJECTIVE: To observe the effect and mechanism of avandia and puerarin used in combination for diabetic nephropathy. METHODS: A total of 180 patients with diabetic nephropathy were randomly divided into 3 groups. The control group (58 patients, group A) were treated with routine therapy including controlling the blood glucose and blood pressure, while 60 patients in group B were treated by avandia besides routine treatment of the control group. Anoter 62 cases in group C were administered with puerarin combined with avandia for 12 weeks. The indexes such as urea nitrogen, serum creatinine, triglyceride, cholesterol, low density lipoprotein, high density lipoprotein, mean arterial pressure, fasting blood glucose, 2h plasma glucose, glycosylated hemoglobin, and 24 h urinary albumin excretion rate were tested before and after the treatment . RESULTS: No significant differences were found in the indexes such as triglyceride, serum cholesterol, low density lipoprotein, high density lipoprotein, glycosylated hemoglobin, malonaldehyde, erythrocuprein, blood urea nitrogen, serum creatinine and 24 h urinary albumin excretion rate among the 3 groups (P>0.05). There were no significant differences in all indexes before and after the treatment in group A (P>0.05) . After the treatment, 24 h urinary albumin excretion, urea nitrogen, serum creatinine, mean arterial pressure, fasting blood glucose, 2 h plasma glucose, glycosylated hemoglobin, triglyceride, serum cholesterol, low density lipoprotein decreased significant (P<0 05) while high density lipoprotein increased significant (P<0.05). CONCLUSION Avandia has better effect on adjusting the blood lipid and decreasing the urinary albumin excretion rate. Puerarin combined with avandia is more effective for improving the renal function and remission of islet function than using avandia alone. Puerarin and avandia have significant synergism.
Adult ; Aged ; Diabetes Mellitus, Type 2 ; complications ; Diabetic Nephropathies ; drug therapy ; etiology ; Drug Therapy, Combination ; Female ; Humans ; Isoflavones ; therapeutic use ; Male ; Middle Aged ; Rosiglitazone ; Thiazolidinediones ; therapeutic use

Eosinophilic peritonitis is defined as when there are more than 100 eosinophils present per milliliter of peritoneal effluent, of which eosinophils constitute more than 10% of its total WBC count. Most cases occur within the first 4 weeks of peritoneal catheter insertion and they usually have a benign and self-limited course. We report a patient of eosinophilic peritonitis that was successfully resolved without special treatment. An 84-year-old man with end stage renal disease secondary to diabetic nephropathy was admitted for dyspnea and poor oral intake. Allergic history was negative. and physical examination was unremarkable. Complete blood count showed a hemoglobin level of 11.1 g/dL, WBC count was 24, 500/mm3 (neutrophil, 93%; lymphocyte, 5%; monocyte, 2%), platelet count was 216, 000/mm3, serum BUN was 143 mg/dL, Cr was 5.7 mg/dL and albumin was 3.5 g/dL. Creatinine clearance was 5.4 mL/min. Three weeks after peritoneal catheter insertion, he was started on peritoneal dialysis with a 6-hour exchange of 2L 1.5% peritoneal dialysate. After nine days, he developed turbid peritoneal effluents with fever (38.4degrees C), abdominal pain and tenderness. Dialysate WBC count was 180/mm3 (neutrophil, 20%; lymphocyte, 4%; eosinophil, 76% [eosinophil count: 136/mm3]). Cultures of peritoneal fluid showed no growth of aerobic or anaerobic bacteria, or of fungus. Continuous ambulatory peritoneal dialysis (CAPD) was commenced, and he was started on intraperitoneal ceftazidime (1.0 g/day) and cefazolin (1.0 g/day). After two weeksr, the dialysate had cleared up and clinical symptoms were improved. Dialysate WBC count decreased to 8/mm3 and eosinophils were not detected in peritoneal fluid. There was no recurrence of eosinophilic peritonitis on follow-up evaluation, but he died of sepsis and pneumonia fifteen weeks after admission.
Aged, 80 and over ; Anti-Bacterial Agents/therapeutic use ; Cefazolin/therapeutic use ; Ceftazidime/therapeutic use ; Diabetic Nephropathies/complications ; Eosinophilia/drug therapy/*etiology ; Humans ; Kidney Failure, Chronic/etiology/therapy ; Male ; Peritoneal Dialysis, Continuous Ambulatory/*adverse effects ; Peritonitis/drug therapy/*etiology

No abstract available.
Administration, Topical ; Anesthesia, Epidural ; Capsaicin/*administration & dosage ; Diabetic Nephropathies/*drug therapy/etiology ; Humans ; Male ; Middle Aged ; *Nerve Block ; Sensory System Agents/*administration & dosage ; Skin Cream

The pathogenesis of diabetic nephropathy is influenced by multiple factors, among them, the pivotal action of inflammation on the development process of diabetic nephropathy has been proven with more and more evidences. In this article, the role of inflammation in the pathogenesis of diabetic nephropathy, the progress on researches of anti-inflammation and immune regulation, as well as the Chinese medicine therapy against diabetic nephropathy are introduced.
Adjuvants, Immunologic ; therapeutic use ; Animals ; Anti-Inflammatory Agents ; therapeutic use ; Diabetic Nephropathies ; drug therapy ; etiology ; Drugs, Chinese Herbal ; therapeutic use ; Humans

In previous studies, the synergistic antiproteinuric effect of the combination therapy of ACE inhibitors and angiotensin II receptor antagonists (ATRAs) has been inconsistent in relation to underlying renal diseases. The influence from the blood pressure (BP) - reducing effect in some studies might also contribute to this inconclusiveness. To examine the possibility of the benefit being different according to underlying renal diseases, we undertook a crossover therapeutic trial of the combination therapy in two selected homogenous groups of patients with diabetic and non-diabetic renal diseases. The BP-reducing effect was excluded during the study. Nineteen biopsy-proven IgA nephropathy, as examples of non-diabetic renal diseases, and 24 type 2 diabetic nephropathy patients were selected as the study subjects. The subjects had to meet the follow criteria: a creatinine clearance (Ccr) between 25 - 90 ml/min/1.73 m2, 24-hr urinary protein excretion rate over 1.0 g/day and a BP maintained at less than 130/80 mmHg, with more than six-month therapy of ramipril, (5.7 +/- 0.4 mg/day, 13 +/- 2 month). The baseline data between the two groups showed no significantly differences. After a 12-week stabilization period (control period), 4 mg, once daily, dose of candesartan (combination period) followed by a placebo (placebo period), or vice versa, were administered in addition to the ramipril, for 12 weeks. The combination, with candesartan, did not change the Ccr, BP, serum and urinary electrolytes or the urea. The 24 hour urinary protein excretion rate was significantly reduced by the combination therapy in the patients with IgA nephropathy (3.1 +/- 0.3 g/day in combination, 4.2 +/- 0.3 in control, and 4.3 +/- 0.2 in placebo; p < 0.05). However, the patients with diabetic nephropathy showed no reduction in their proteinuria with the combination therapy (3.8 +/- 0.2 g/day in combination, 3.9 +/- 0.3 in control, and 4.1 +/- 0.3 in placebo; p=NS). The changes in proteinuria showed no relationship with the changes in the BP in IgA nephropathy. In conclusions, the benefit of combination therapy of its antiproteinuric effect was different between IgA and diabetic nephropathy over the 12-week trial. The difference in the pathophysiological role, and the importance of the renin- angiotensin system, between the two diseases might contribute to the discrepancy in the result. We suggest the discrimination of the underlying renal diseases in the study subjects is an important prerequisite for future studies on this issue.
Adult ; Angiotensin-Converting Enzyme Inhibitors/*therapeutic use ; Cross-Over Studies ; Diabetic Nephropathies/*urine ; Double-Blind Method ; Drug Therapy, Combination ; Female ; Glomerulonephritis, IGA/*urine ; Human ; Male ; Middle Aged ; Proteinuria/*drug therapy/*etiology ; Receptors, Angiotensin/*antagonists & inhibitors ; Treatment Outcome

Aim of this article was to investigate relationship between inflammatory pathogenesis of diabetic nephropathy and the TCM pathogenetic theory of Shen-Collateral impaired by Toxin, and to illustrate the method for removing toxin, activating collateral and protecting Shen can be an effective treatment for inhibiting the inflammatory pathogenesis of diabetic nephropathy.
Chemokine CCL2 ; biosynthesis ; genetics ; Diabetic Nephropathies ; drug therapy ; etiology ; metabolism ; Diagnosis, Differential ; Drugs, Chinese Herbal ; therapeutic use ; Female ; Humans ; Inflammation ; complications ; metabolism ; Male ; Medicine, Chinese Traditional ; NF-kappa B ; biosynthesis ; genetics ; Phytotherapy

No abstract available.
Aged ; Anti-Bacterial Agents/*adverse effects ; Anticonvulsants/therapeutic use ; Cephalosporins/*adverse effects ; Consciousness Disorders/diagnosis/drug therapy/*etiology ; Diabetic Nephropathies/complications/*therapy ; Electroencephalography ; Female ; Humans ; Pneumonia, Bacterial/complications/*drug therapy ; *Renal Dialysis ; Status Epilepticus/diagnosis/drug therapy/*etiology ; Treatment Outcome ; Uremia/therapy

OBJECTIVETo observe the therapeutic effect of Tongluo capsule (TLC) in treating diabetic nephropathy (DN) complicated chronic renal failure (CRF), and to explore its mechanism preliminarily.

METHODSNinety-seven patients with DN-CRF were randomly divided into the TCM group (n = 50) and the WM group (n = 47) to observe the changes of urinary protein per 24 hrs (UP/24h), renal function, creatinine (Cr), blood urea nitrogen (BUN), blood lipids (TG, TC, HDL-C, LDL-C) and serum transforming growth factor-beta1 (TGF-beta1) before and after treatment.

RESULTSAfter 6 months of treatment, levels of UP/24h, Cr, BUN and TGF-beta1 significantly lowered in both groups (P<0.01), and a better effect was showed in the TCM group in aspects of lowering Cr, BUN and TGF-beta1 (P<0.01). Besides, TLC also showed effect in lowering the serum lipid parameters (P<0.05 or P<0.01).

CONCLUSIONEffect of TLC in treating DN-CRF might be through lowering the levels of blood lipids and serum TGF-beta1.

Adult ; Albuminuria ; drug therapy ; Blood Urea Nitrogen ; Capsules ; Creatinine ; blood ; Diabetic Nephropathies ; complications ; drug therapy ; Drugs, Chinese Herbal ; therapeutic use ; Female ; Humans ; Kidney Failure, Chronic ; drug therapy ; etiology ; Lipids ; blood ; Male ; Middle Aged ; Phytotherapy ; Tongue ; Transforming Growth Factor beta ; blood ; Transforming Growth Factor beta1

OBJECTIVETo observe the clinical effect of Qidi Yiqi Yangyin Huoxue Recipe (QYYHR) on diabetic nephropathy (DN) at stage III and IV.

METHODSOne hundred type 2 DN patients of qi-yin deficiency with blood-stasis syndrome were randomly divided into two groups, all were treated with basal hypoglycemic treatment but with QYYHR given to the treatment group additionally for 3 months. The symptoms were observed, blood glucose, urinary albumin excretion rate (UAER), blood urea nitrogen (BUN), creatinine (Cr) and hemorheological parameters were detected before and after treatment.

RESULTSThe total effective rate was higher in the treatment group than that in the control group (89.6% vs. 68.1%, P < 0.01), and the improvement of UAER, BUN, Cr and hemorheological parameters was also significantly better in the former than in the latter (P < 0.05).

CONCLUSIONQYYHR has favorable effects on type 2 DN of qi-yin deficiency with blood-stasis syndrome.

Adult ; Aged ; Albuminuria ; urine ; Blood Glucose ; metabolism ; Blood Urea Nitrogen ; Creatinine ; blood ; Diabetes Mellitus, Type 2 ; complications ; Diabetic Nephropathies ; blood ; drug therapy ; etiology ; Drugs, Chinese Herbal ; therapeutic use ; Female ; Hemorheology ; drug effects ; Humans ; Male ; Middle Aged ; Phytotherapy ; Qi ; Treatment Outcome ; Yin Deficiency ; drug therapy

BACKGROUND/AIMS: Renal hypoxia is involved in the pathogenesis of diabetic nephropathy. Pentoxifyllin (PTX), a nonselective phosphodiesterase inhibitor, is used to attenuate peripheral vascular diseases. To determine whether PTX can improve renal hypoxia, we investigated its effect in the streptozocin (STZ)-induced diabetic kidney. METHODS: PTX (40 mg/kg, PO) was administered to STZ-induced diabetic rats for 8 weeks. To determine tissue hypoxia, we examined hypoxic inducible factor-1alpha (HIF-1alpha), heme oxygenase-1 (HO-1), vascular endothelial growth factor (VEGF), and glucose transporter-1 (GLUT-1) levels. We also tested the effect of PTX on HIF-1alpha in renal tubule cells. RESULTS: PTX reduced the increased protein creatinine ratio in diabetic rats at 8 weeks. HIF-1alpha, VEGF, and GLUT-1 mRNA expression increased significantly, and the expression of HO-1 also tended to increase in diabetic rats. PTX significantly decreased mRNA expression of HIF-1alpha and VEGF at 4 and 8 weeks, and decreased HO-1 and GLUT-1 at 4 weeks. The expression of HIF-1alpha protein was significantly increased at 4 and 8 weeks in tubules in the diabetic rat kidney. PTX tended to decrease HIF-1alpha protein expression at 8 weeks. To examine whether PTX had a direct effect on renal tubules, normal rat kidney cells were stimulated with CoCl2 (100 microM), which enhanced HIF-1alpha mRNA and protein levels under low glucose conditions (5.5 mM). Their expressions were similar even after high glucose (30 mM) treatment. PTX had no effect on HIF-1alpha expression. CONCLUSIONS: PTX attenuates tubular hypoxia in the diabetic kidney.
Animals ; Anoxia/*drug therapy/enzymology/etiology/genetics ; Cell Line ; Cobalt/pharmacology ; Diabetes Mellitus, Experimental/*complications ; Diabetic Nephropathies/*drug therapy/enzymology/etiology/genetics ; Disease Models, Animal ; Gene Expression Regulation/drug effects ; Glucose/metabolism ; Glucose Transporter Type 1/genetics ; Heme Oxygenase (Decyclizing)/genetics/metabolism ; Hypoxia-Inducible Factor 1, alpha Subunit/genetics/metabolism ; Kidney Tubules/*drug effects/enzymology ; Male ; Pentoxifylline/*pharmacology ; Phosphodiesterase Inhibitors/*pharmacology ; RNA, Messenger/metabolism ; Rats ; Rats, Sprague-Dawley ; Streptozocin ; Time Factors ; Vascular Endothelial Growth Factor A/genetics