OBJECTIVETo observe the effect of Yishen Jiedu Recipe (YSJDR) in retarding the course of chronic renal failure (CRF).

METHODSForty-five patients were divided into two groups, the 22 patients in Group A were treated with low-protein diet and blood pressure controlling therapy only, while the 23 patients in Group B were treated with additional YSJDR. The time (month) for doubling serum creatinine (SCr) level was taken to evaluate the speed of CRF progression.

RESULTSIn Group A, the time for SCr increased from 288.4 +/- 96.7 mumol/L to 586.3 +/- 251.3 mumol/L was 16.7 +/- 5.1 months, while in Group B the time for SCr increased from 291.2 +/- 101.2 mumol/L to 589.6 +/- 257.5 mumol/L was 28.2 +/- 8.7 months. Comparison between the two groups showed significant difference (P < 0.05).

CONCLUSIONOn the basis of low-protein diet and blood pressure controlling therapy, the additional treatment of YSJDR could markedly retard the progression speed of CRF.

Adult ; Creatinine ; blood ; Drugs, Chinese Herbal ; therapeutic use ; Female ; Humans ; Kidney Failure, Chronic ; drug therapy ; Male ; Middle Aged ; Phytotherapy

OBJECTIVETo evaluate the effect of Xinshen capsule upon the chronic kidney disease progress by the study of 7/8 kidney removal rat model.

METHODThe urea nitrogen and the blood creatinine level were estimated by automatic biochemistry analyzer. Hemorheological index level was measured by rheometer. Urine protein was measured by Coomassie brilliant blue. PAS and PASM staining was applied to observe kidney histology change, and semi-quantitative analysis was used to observe the kidney histology change.

RESULTIn model control group, the urine protein excretory rate and the urea nitrogen, the blood creatinine level were up-regulated obviously, erythrocyte aggregation index and whole blood viscosity value were down-regulated significantly, kidney organizations show up pathological change evidently, and leave surgical group compared the difference. After the treatment of Xinshen capsule, the above indicators are improving obviously.

CONCLUSIONXinshen capsule can degrade urine protein, the urea nitrogen and the blood creatinine level, and lower red blood cell accumulation and the whole blood viscosity, alleviate kidney various pathological change, the medicine can effectively delay the progress of chronic kidney disease.

Animals ; Blood Urea Nitrogen ; Blood Viscosity ; drug effects ; Capsules ; Creatinine ; blood ; Erythrocyte Aggregation ; drug effects ; Female ; Kidney ; drug effects ; pathology ; Kidney Failure, Chronic ; blood ; drug therapy ; pathology ; Medicine, Chinese Traditional ; Proteinuria ; urine ; Rats ; Rats, Sprague-Dawley

OBJECTIVETo investigate the effects of alpha-keto acid on the expression of neuropeptide Y in malnutrition rats with chronic renal failure.

METHODSSD rats received 5/6 nephrectomy and were fed with 4% casein to establish models of malnutrition with chronic renal failure. Serum albumin, urea nitrogen, serum creatinine, type-1 insulin like growth factor and body weight of the rats were measured. The rat models were randomized into chronic renal failure group, alpha-keto acid group and normal control group, and after a 4-week treatment as indicated, neuropeptide Y mRNA levels in the hypothalamus were measured by RT-PCR in rats with surgically induced renal failure (two-stage subtotal nephrectomy). The blood neuropeptide Y of the rats were analyzed by radioimmunoassay.

RESULTSMalnutrition occurred in chronic renal failure rats at the end of 10 weeks. Compared with those in the chronic renal failure group, the plasma neuropeptide Y concentrations in alpha-keto acid group were significantly lowered with substantially elevated neuropeptide Y mRNA expression in the hypothalamus.

CONCLUSIONalpha-keto acid capsule can improve malnutrition in rats with renal insufficiency possibly by up-regulating neuropeptide Y mRNA expression in the hypothalamus and reducing the level of blood neuropeptide Y.

Animals ; Hypothalamus ; metabolism ; Keto Acids ; pharmacology ; therapeutic use ; Kidney Failure, Chronic ; blood ; Male ; Malnutrition ; blood ; drug therapy ; Neuropeptide Y ; blood ; RNA, Messenger ; genetics ; Rats ; Rats, Sprague-Dawley

OBJECTIVETo assess the impact of Paidu Baoshen Pill (PBP, modified Dahuang Zhechong Pill), in retarding the procession of chronic renal failure (CRF) of stage II-III.

METHODSThe 283 patients of CRF stage II-III were randomly assigned to two groups, 151 patients in the treatment group treated with oral administration of PBP 3 g twice a day, and 132 patients in the control group with oxidative amylase aldehyde enveloped capsule 5-10 capsules thrice a day after meal. The course for both groups was 2 months, and the changes after 1 or 2 courses treatment in scoring of quality of life (QOL) and clinical symptoms, also in laboratory indexes including serum levels of creatinine (Cr), urea nitrogen (UN), and intrinsic creatinine clearance rate were observed.

RESULTSThe total effective rate was 70. 86% (107/151 cases) in the treatment group and 44.70% (59/132 cases) in the control group, showing significant difference between them (X2 = 18.69, P < 0.01). Significant differences between groups were also shown in comparisons of scores of QOL and clinical symptoms after treatment. Inter-group comparison showed no difference in all the three indexes detected before treatment, but they did show statistical significance respectively after 1 and 2 courses of treatment (P < 0.05 and P < 0.01).

CONCLUSIONPBP could effectively retard the progression of chronic renal failure and significantly improve the QOL of patients.

Adult ; Aged ; Creatinine ; blood ; Disease Progression ; Drugs, Chinese Herbal ; administration & dosage ; Female ; Humans ; Kidney Failure, Chronic ; blood ; drug therapy ; pathology ; Male ; Middle Aged ; Quality of Life ; Young Adult

OBJECTIVETo compare the effect on erythropoietin (Epo) resistance between acupoint injection and subcutaneous injection of rHuEpo in patients with chronic renal failure (CRF).

METHODSThirty-eight cases were randomly divided into two groups, 19 cases in each one. In subcutaneous injection group (control group), subcutaneous injection of rHuEpo was administered, 3 times a week, lasting 2 months. In acupoint group (observation group), rHuEpo was injected on unilateral Shenshu (BL 23) and Zusanli (ST 36), one point was chosen each time, the bilateral acupoints were injected alternatively, 3 times a week, for 2 months. Meanwhile, a normal control group of 19 healthy persons was set up. The levels of CRP, IL-6, TNF-alpha, Scr, BUN, Hb, Hct and SF were observed.

RESULTSBefore treatment, the values of CRP, IL-6 and TNF-alpha in two groups were all higher than those in normal control group (all P < 0.01). After treatment for 2 months, the values of CRP, IL-6,TNF-alpha, Scr and BUN in two groups decreased apparently and those of Hb, Hct and SF increased obviously, indicating statistic significant differences as compared with the values before treatment separately (P < 0.05, P < 0.01). In comparison between two groups after treatment, every index above in observation group was improved much significantly (P < 0.05, P < 0.01).

CONCLUSIONAcupoint injection of rHuEpo at Zusanli (ST 36) and Shenshu (BL 23) increases significantly the values of Hb, Hct and SF, and decreases apparently the values of BUN, Scr and inflammatory factors, such as CRP, IL-6 and TNF-alpha as compared with subcutaneous injection. Acupoint injection improves Epo resistance and enhances Epo efficacy via alleviating micro-inflammatory state of the body.

Acupuncture Points ; Adult ; Aged ; Drug Resistance ; Erythropoietin ; administration & dosage ; Female ; Humans ; Inflammation Mediators ; blood ; immunology ; Injections, Subcutaneous ; Interleukin-6 ; blood ; immunology ; Kidney Failure, Chronic ; blood ; drug therapy ; immunology ; Male ; Middle Aged ; Recombinant Proteins ; Tumor Necrosis Factor-alpha ; blood ; immunology

OBJECTIVETo observe the plasma levels of p-selectin (CD62 P) and intercellular adhesion molecule-1 (ICAM-1) in patients with sharp deteriorated chronic renal failure (CRF) of damp-heat syndrome type (DHS), and the curative efficacy of Qingshen Granule (QSG) on the disease.

METHODSSixty cases with sharp deteriorated CRF of DHS were equally randomized to the treated group and the control group, all were treated with conventional Western medical therapy combining with retention enema of Jiedu Xiezhuo No. II; but for patients in the treated group, QSG was given additionally, 1 bag thrice a day by oral intake. The therapeutic course for all was 1 month. Besides, a group of 20 healthy persons was set up for normal control. Plasma levels of CD62 P and ICAM-1 were measured before and after treatment, and were compared with those in the normal control.

RESULTSBoth the total effective rate on disease and on Chinese medicine syndrome in the treated group were 90.0% (27/30), significantly higher than those in the control group, 60.0% (18/30) and 63.3% (19/30), respectively, showing significant differences between groups (P < 0.05). Plasma levels of CD62 P and ICAM-1 were obviously higher before treatment as compared to those in the normal control group (P < 0.01), which reduced markedly after treatment in both treated group and control group (P < 0.05), but the changes in the treated group were more significant (P < 0.05).

CONCLUSIONSPatients with sharp deteriorated CRF of DHS show higher plasma levels of CD62 P and ICAM-1 in comparing with the normal control. Treatment of retention enema with QSG in combined with JDXZ No. II could reduce the two indexes more significantly than that using retention enema alone, and the combined therapy could also improve renal function and ameliorate clinical symptoms in patients.

Adolescent ; Adult ; Aged ; Drugs, Chinese Herbal ; therapeutic use ; Female ; Humans ; Intercellular Adhesion Molecule-1 ; blood ; Kidney Failure, Chronic ; blood ; diagnosis ; drug therapy ; Male ; Medicine, Chinese Traditional ; methods ; Middle Aged ; P-Selectin ; blood ; Phytotherapy ; Young Adult

BACKGROUND: Considering that dialysate calcium concentration is potentially a main determinant of the serum ionized calcium level and vasoconstriction is associated with the blood calcium concentration, we conducted a study to evaluate the interdialytic effects of treatment with a low calcium dialysate (LdCa, 1.25 mmol/L) on the changes in arterial compliance (AC), blood pressure (BP), biochemical parameters and vasoactive substances. METHODS: Eight hemodialysis (HD) patients (mean age: 46.8 +/- 13.7 years, 4 men and 4 women) were included in the study. AC, systolic blood pressure (SBP), diastolic blood pressure (DBP), pulse pressure (PP), mean arterial pressure (MAP), serum ionized Ca, intact-PTH, serum nitric oxide and aldosterone were compared after 10 sessions of treatment with LdCa. Right carotid artery diameter was measured 3 times using a real time B-mode ultrasound imager (Hewlett-Packard Sonos 2000 (R) ) and AC was calculated using the Hayoz method. RESULTS: 1) AC was recorded as 0.140 (0.080-0.170) mm2/kPa at the baseline (1.75 mmol/L calcium dialysate), 0.170 (0.050-0.290) mm2/kPa after LdCa treatment (p< 0.05 versus baseline), and 0.140 (0.070-0.250) mm2/kPa following the HdCa treatment (p< 0.05 versus LdCa data). 2) MAP and PP were calculated at 114.12 +/- 10.56 mmHg and 63.50 +/- 10.87 mmHg at the baseline; 98.37 +/- 15.14 mmHg and 56.50 +/- 5.95 mmHg after LdCa treatment (p< 0.05 versus baseline) ; and 115.75 +/- 9.64 mmHg and 62.00 +/- 15.71 mmHg following HdCa treatment (p< 0.05 versus LdCa data). 3) Serum ionized Ca and intact-PTH were measured at 4.66 +/- 0.40 mg/dL and 25.08 +/- 16.44 pg/mL at the baseline; 4.45 +/- 0.28 mg/dL and 90.71 +/- 27.03 pg/mL after LdCa treatment (p< 0.05 versus baseline) ; and 4.65 +/- 0.43 mg/dL and 24.08 +/- 15.44 pg/mL following HdCa treatment (p< 0.05 versus LdCa data). 4) Serum aldosterone concentration was 300.8 (65.5-836.1) pg/mL at the baseline, and 220.2 (42.8-527.9) pg/mL after LdCa treatment (p< 0.05). CONCLUSION: There were favorable changes in AC, BP, biochemical parameters after treatment with LdCa. These changes may be associated with the reduction in serum ionized calcium and decreased serum aldosterone concentration.
Adult ; Arteries/drug effects ; Blood Pressure/*drug effects ; Calcium/*pharmacology ; Compliance/drug effects ; Cross-Over Studies ; Dialysis Solutions/*pharmacology ; Female ; Human ; Kidney Failure, Chronic/*physiopathology/therapy ; Male ; Middle Aged ; *Renal Dialysis ; Support, Non-U.S. Gov't

Chronic renal failure (CRF) is a functional diagnosis characterized by a progressive and generally irreversible decline in glomerular filtration rate (GFR). It is caused by a number of diseases, most commonly diabetes, glomerulonephritis, hypertension and the genetic diseases. The renal function of CRF patients declines by unrelenting progressive loss of nephron that persists long after the inciting event. CRF is not a curable disease. The aim of the treatment of CRF is to halt or delay the progression of renal failure and amelioration of symptoms, not to cure of the disease. Systemic hypertension, glomerular hypertension, proteinuria and protein-rich diet contribute to the progression of renal failure. Restriction of dietary protein intake help to preserve residual renal function. Among the antihypertensives, angiotensin converting enzyme inhibitor (ACEI) is the drug of choice for blood pressure control in CRF patients, because this class of drug reduces intraglomerular pressure. There is a growing awareness of a need not only to identify CRF patients at an earlier stage in the disease process, but also to initiate treatment strategies earlier to delay progression of CRF and to define the optimal time required to prepare CRF patients for renal replacement therapy. Early referral to the nephrologist is important for timely intervention. The consequences of late referral include increased morbidity and mortality. There is also an impact on patient's quality of life and missed opportunities for pre-emptive transplantation. Late referral also limits therapeutic options, and these limitations exert adverse effects on long-term outcomes once patients are on dialysis.
Antihypertensive Agents ; Blood Pressure ; Diagnosis ; Dialysis ; Diet ; Diet Therapy ; Dietary Proteins ; Drug Therapy ; Glomerular Filtration Rate ; Glomerulonephritis ; Humans ; Hypertension ; Kidney Failure, Chronic* ; Mortality ; Nephrons ; Peptidyl-Dipeptidase A ; Proteinuria ; Quality of Life ; Referral and Consultation ; Renal Insufficiency ; Renal Replacement Therapy

We investigated to see whether an altered role of nitric oxide (NO) system is involved in erythropoietin (EPO)-induced hypertension in chronic renal failure (CRF). Male Sprague-Dawley rats were five-sixths nephrectomized to induce CRF. Six weeks after the operation, EPO or vehicle was injected for another 6 weeks. Plasma and urine nitrite/nitrate (NOx) levels were determined. Expression of NO synthase (NOS) proteins in the aortae and kidneys were also determined. In addition, the isometric tension of isolated aorta in response to acetylcholine and nitroprusside was examined. Blood pressure progressively rose in CRF groups, the degree of which was augmented by EPO treatment. Plasma NOx levels did not differ among the groups, while urine NOx levels were lower in CRF groups. Endothelial NOS expression was lower in the kidney and aorta in CRF rats, which was not further affected by EPO-treatment. The inducible NOS expression in the kidney and aorta was not different among the groups. Acetylcholine and sodium nitroprusside caused dose-dependent relaxations of aortic rings, the degree of which was not altered by EPO-treatment. Taken together, EPO-treatment aggravates hypertension in CRF, but altered role of NO system may not be involved.
Acetylcholine/pharmacology ; Anemia/metabolism ; Anemia/etiology ; Anemia/drug therapy* ; Animal ; Aorta, Thoracic/physiology ; Body Weight ; Erythropoietin/pharmacology* ; Hypertension, Renal/metabolism ; Hypertension, Renal/drug therapy ; Isometric Contraction/drug effects ; Kidney/enzymology ; Kidney Failure, Chronic/metabolism* ; Kidney Failure, Chronic/complications ; Male ; Nitrates/urine ; Nitrates/blood ; Nitric Oxide/metabolism* ; Nitric-Oxide Synthase/metabolism ; Nitrites/urine ; Nitrites/blood ; Nitroprusside/pharmacology ; Rats ; Rats, Sprague-Dawley ; Vasoconstriction/drug effects ; Vasoconstrictor Agents/pharmacology ; Vasodilator Agents/pharmacology

This study was designed to examine how such factors as hemodialysis parameters, body mass index, renin and aldosterone concentrations, sympathetic nervous activity, and parathyroid hormone concentrations are associated with the control of hypertension in hemodialysis patients. Hemodialysis patients (n=114) were grouped into four categories. Group 1 had normal BP without antihypertensive medication. Group 2 needed one antihypertensive drug, Group 3 needed combination of two or three categories of antihypertensive drugs without minoxidil. Group 4 needed more than three categories of antihypertensive drugs including minoxidil. Parathyroid hormone, beta2-microglobulin, renin and aldosterone, epinephrine, norepinephrine, and hemodialysis parameters were measured. The fractional clearance of urea as Kt/V urea was significantly lower in Group 3 and Group 4 than in Group 2 (p<0.01). Concentrations of parathyroid hormone were significantly higher in Group 4 than the other groups (p<0.01). Pre-hemodialysis norepinephrine concentrations were significantly higher in Group 4 than the other groups (p<0.05). Traditional factors associated with hypertension did not seem to be relevant to the degree of hypertension in hemodialysis patients in the present study. In conclusion, poor Kt/V urea, elevated parathyroid hormone concentrations, and elevated concentrations of plasma norepinephrine seemed to be the factors that might be associated with control of hypertension in hemodialysis patients.
Adult ; Aged ; Aldosterone/*blood ; Analysis of Variance ; Antihypertensive Agents/therapeutic use ; Blood Pressure/drug effects/*physiology ; Epinephrine/blood ; Female ; Humans ; Hypertension/blood/drug therapy/physiopathology ; Kidney Failure, Chronic/blood/physiopathology/therapy ; Male ; Middle Aged ; Norepinephrine/blood ; Parathyroid Hormone/*blood ; *Renal Dialysis ; Renin/*blood ; Sympathetic Nervous System/*physiology ; Urea/metabolism