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Wednesday, June 29, 2016

General Health: Chronic Renal Failure -Can dialysis be delayed? and Chronic renal failure be treated?

Kyle J. Norton(Scholar, Master of Nutrients), all right reserved.
Health article writer and researcher; Over 10.000 articles and research papers have been written and published on line, including world wide health, ezine articles, article base, healthblogs, selfgrowth, best before it's news, the karate GB daily, etc.,.
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Some articles have been used as references in medical research, such as international journal Pharma and Bio science, ISSN 0975-6299.

Chronic renal failure is defined as a condition of progression of damage of kidney over a period of months or years of that the organs are no longer perform theirs function of blood filtering and have decreased capability to excrete waste products. In early stage of renal failure, Creatinine levels may be normal in the early stages of CKD, and the condition is discovered if urinalysis (testing of a urine sample) shows that the kidney is allowing the loss of protein or red blood cells into the urine(1).

Some studies found that high protein diet accelerate the progression of disease(2), other suggested that there is a link between the quantity of protein intake and the rate of renal deterioration is suggested by preliminary prospective studies among incident peritoneal dialysis patients, renal transplant recipients, and animal models of kidney disease(3). Animal experiments have given strong evidence that, in the case of nephron loss, high dietary protein promotes further loss of renal function(4). But other study suggested after this 4-month period, the rate of decline in GFR was slower in patients on the low protein diet. This suggests but does not prove that low protein diet may slow progression of renal disease in the long run. MDRD also showed that strict control of hypertension slows progression in patients with heavy proteinuria.(5).

In the following up interview with patient relatives, a 58 years of age was diagnosed with early stage of renal failure with kidney functions of 10 percents with no any adversed symptoms. After 8 years, he entered the last stage of renal failure and required twice weekly dialysis. Patient lived for another 10 years before losing his will to live. Another 75 years of age male was diagnosed with early stage of renal failure with kidney function of 15 % with no adversed symptoms. After 2 years, the disease was progressed aggressively as he required twice weekly dialysis and 2 years later, he died as he no longer wished to live, we found out that diet has played an essential role in delaying the progression of the disease.

Can dialysis be delayed? and Chronic renal failure be treated?
There is no effective treatment in Western medicine but dialysis in elder (Acute renal failure of younger adult may be luckily enough to get a kidney transplant, but in elder, such transplant may differentiate according to risks involved). In a study of Common syndrome factors of traditional Chinese medicine in chronic renal failure based on the questionnaire investigation among experts, chronic renal failure can be classified into excess type such as dampness, turbid toxin, blood stasis, water retention, and phlegm and deficiency type such as qi deficiency, yin deficiency, yang deficiency, blood deficiency, and essence deficiency(6), depending to differentiation.
In medical studies, Certain Chinese herbal formulas have found to be effective in treating patients with early diagnosis of chronic renal failure as well as late stage of the diseases
1. Shen Shuai Ling
Shenshuailing Kou Fu Ye, (the Oral Liquid for Renal Failure) and Shenshuailing Guan Chang Ye ( the Enema for Renal Failure) have found to be effective in treating chronic renal failure. In the clinical symptoms, serum creatinine, blood urea nitrogen and creatinine clearance rate were observed. The total effective rate in the former was 90.46%, and the latter 60.43%(7).

2. Niao Du Jing in the study of 105 renal failure patients, found to be effective as the serum creatinine, blood urea nitrogen and middle molecular substance were decreased and creatinine clearance rate was increased significantly after NDJ treatment as compared with before treatment (P < 0.05-0.01)(8).

3. Kangqianling decoction (KQL), the modified formulation of a classical Chinese prescription named Taohongsiwu decoction, has also found to be effective in treating renal failure in rat. Dr. He L and the team at the Shanghai University of Traditional Chinese Medicine said “In renal function deterioration progression, the high expression of serum creatinine (Scr), 24-h urine protein and systolic blood pressure were markedly (P<0.05 or P<0.01) restored by KQL, respectively, at 4 and 8 weeks. The increasing expressions of renal Ang II (P<0.05), angiotensin II1-receptor (AT1R) (P<0.05), TNF-alpha (P<0.05), NF-kappaB (P<0.001) and urine TGF-beta1 (P<0.05) were reduced by the treatment of KQL. Immunohistochemical study further confirmed the nephro-protective activity of KQL as compared to the control and Sham group(9).

4. Dr. Wei FN, and the research team at the Guangdong Provincial Hospital of TCM indicated that Chinese herbs for replenishing qi and activating blood circulation on platelet membranous glycoprotein CD62P in patients with chronic renal failure (CRF) undergoing hemodialysis, may be associated with the mechanism of Chinese herbs in treating CRF(10). Other researchers at the General Hospital of PLA , Beijing found that the effect and safety of Chinese medicineCompound Shenhua Tablet (SHT) on IgA nephropathy patients of TCM Qi-yin deficiency syndrome type, by using angiotensin-converting enzyme inhibitors (ACEI) fosinopril as the positive control(11).
5. Tongluo capsule is also found to be effective in treating diabetic nephropathy caused chronic renal failure lowering the levels of blood lipids and serum TGF-beta1(12)

6. Shenqi Jiedu Decoction is found to delay the progress of CRF by inhibiting TGF-beta1/Smads signal transduction pathway(13).

7. Chinese herbs invigorate Spleen to remove dampness, activate blood circulation to eliminate Turbid in retarding progression of chronic renal failure (CRF)(14), Thirty-nine patients with CRF treated with these herb were found that the progression of CRF was estimated by slope of the creatinine reciprocal (1/SCr) with time (month).

8. In a Clinical study on treatment of early diabetic nephropathy by tangshenling combined with telmisartan, showed that combination of TSL and telmisartan has a better effect than telmisartan on DN in early stage. Its mechanism might be related to the decrease of ANP and TGF-beta1 and improvement of lipids metabolism and renal tubular interstitial pathological changes(15).

9. Formula Liuwei Dihuang Pill (LDP) also showed to inhibit the activity of EAR in patients with early DN, improve various indexes of DN, so as to be helpful for its treatment(16). Shen Tekang capsules (capsules for improving the renal function) was administered to patients for strengthening the viability and improving the nutrition state, and the recipe for treating renal function failure (both formulated by the authors) for improving the renal function so as to decrease the frequency and duration of dialysis(17).

10. In the study of the complications due to continuous ambulatory peritoneal dialysis for chronic renal failure, according to Dr. Wei L, and the research team at the First Military Medical University
a. Modified Renshen Yangrong Tang (Ginseng Nutrition Decoction) was used for anorexia and hypoproteinemia;

b. Modified Xiangsha Liujunzi Tang (Decoction of Cyperus and Amomum with Six Noble Ingredients) for abdominal pain and distension; modified Da Chaihu Tang (Major Bupleurum Decoction) for peritonitis.

c. Modified Shenling Baizhu San (Powder of Ginseng, Poria and Atractylodes) for diarrhea due to insufficiency of the spleen with abundance of dampness.

d. Lizhong Tang (Decoction for Regulating the Function of Middle-jiao) and modified Sishen Wan (Pills of Four Miraculous Drugs) for insufficiency of both the spleen and the kidney.

c. Siwu Tang (Decoction of Four Ingredients) added with other drugs for cutaneous pruritus, and Guishao Sijunzi Tang (Decoction of Four Noble Drugs added with Chinese Angelica Root and white Peony Root) for renal anemia.

d. The therapeutic principles of invigorating the liver and kidney, strengthening the bones and muscles, and promoting blood circulation to eliminate blood stasis were adopted in the treatment of renal osteopathy, and the therapeutic principles of invigorating the liver and kidney, expelling phlegm and resolving dampness, and promoting blood circulation to eliminate blood stasis in the treatment of hyperlipemia.

e. Shen Tekang capsules (capsules for improving the renal function) was administered to patients for strengthening the viability and improving the nutrition state, and the recipe for treating renal function failure (both formulated by the authors) for improving the renal function so as to decrease the frequency and duration of dialysis(18).

Finally, we could like to conclude the article with a study of the curative effect of integrated traditional Chinese and western medicine (TCM-WM) on incipient diabetic nephropathy (DN). In a study of one hundred patients with incipient DN randomly divided into two groups, the treatment group (50 cases) was treated with TCM-WM therapy, which was carried out by using Jiangtang Janshenling (JTJSL) capsule, a Chinese preparation for supplementing Qi and nourishing Yin, on the basis of controlling blood glucose with western medicine effectively, researchers found that the total effective rate in the treatment group was 90% while that in the control group was 58%, the difference between two groups was significant (P < 0.05). 24 hours urinary albumin excretion, blood sugar, microalbuminuria, blood and urine beta 2-microglobulin, blood lipids, and hemorrheology levels were all improved after treatment in the treatment group (P < 0.05 or P < 0.01)(17). 

Other study found that for the patients with CKD stage 3, TCM can improve eGFR and hemoglobin with lower side effects. Benazepril significantly decreased the proteinuria. Chinese medicine integrated with benazepril can ameliorate renal function and decrease proteinuria synergistically(19).

Please consult with your traditional Chinese medicine practitioner before applying.

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Sources
(1) http://en.wikipedia.org/wiki/Chronic_kidney_disease
(2) http://www.igansupport.org/articles/restrictingprotein.html
(3) http://www.ncbi.nlm.nih.gov/pubmed/15073493
(4) http://www.ncbi.nlm.nih.gov/pubmed/8568491
(5) http://www.ncbi.nlm.nih.gov/pubmed/7939916
(6) http://www.ncbi.nlm.nih.gov/pubmed/21144457
(7) http://www.ncbi.nlm.nih.gov/pubmed/11498911
(8) www.ncbi.nlm.nih.gov/pubmed/9772612
(9) http://www.ncbi.nlm.nih.gov/pubmed/19146937
(10) http://www.ncbi.nlm.nih.gov/pubmed/17342993
(11) http://www.ncbi.nlm.nih.gov/pubmed/17342992
(12) http://www.ncbi.nlm.nih.gov/pubmed/15366593
(13) http://www.ncbi.nlm.nih.gov/pubmed/20226149
(14) http://www.ncbi.nlm.nih.gov/pubmed/11938803
(15) http://www.ncbi.nlm.nih.gov/pubmed/16883907
(16) http://www.ncbi.nlm.nih.gov/pubmed/15658651
(17) http://www.ncbi.nlm.nih.gov/pubmed/11789241
(18) http://www.ncbi.nlm.nih.gov/pubmed/10453576
(19) http://www.ncbi.nlm.nih.gov/pubmed/22178174
                

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