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      Effect of Astragalus membranaceus extract on diabetic nephropathy

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      Author(s): , 1 , 2 ,
      Publication date (Electronic):
      Journal: Endocrinology, Diabetes & Metabolism Case Reports
      Publisher: Bioscientifica Ltd

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          Summary

          Diabetic nephropathy, a microvascular complication of diabetes, is a progressive kidney disease caused by angiopathy of the capillaries in the kidney glomeruli. Herein, we report a case of a 62-year-old patient with a 30 year history of diabetes, who showed a substantial improvement in diabetic nephropathy on administration of 30 g of Astragalus membranaceus extract per day. After 1 month, estimated glomerular filtration rate increased from 47 to 72 ml/min per 1.73 m 2 and was subsequently maintained at the 1-month follow-up. Urinary protein levels also decreased following treatment. Herein, we present and discuss the evidence and mechanism of A. membranaceus on diabetic nephropathy in this patient.

          Learning points

          • Diabetic nephropathy is a progressive kidney disease.

          • Angiotensin-converting enzyme (ACE) inhibitors or angiotensin receptor blockers (ARBs) are currently used to prevent and delay the progression of diabetic nephropathy. However, their effects are not sufficient to prevent a decline in kidney function.

          • Furthermore, combination therapy with an ACE inhibitor and an ARB can produce adverse effects without additional benefits.

          • In the early phase of diabetic nephropathy, administration of Astragalus membranaceus can be a therapeutic option.

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          Astragaloside IV ameliorates renal injury in streptozotocin-induced diabetic rats through inhibiting NF-κB-mediated inflammatory genes expression.

          Dingkun Gui, Jianhua Huang, Yongping Guo … (2013)
          Accumulating evidence suggests that inflammatory processes are involved in the development of diabetic nephropathy (DN). However, there are no effective interventions for inflammation in the diabetic kidneys. Here, we tested the hypothesis that Astragaloside IV(AS-IV), a novel saponin purified from Astragalus membranaceus (Fisch) Bge, ameliorates DN in streptozotocin (STZ)-induced diabetic rats through anti-inflammatory mechanisms. Diabetes was induced with STZ (65 mg/kg) by intraperitoneal injection in rats. Two weeks after STZ injection, rats were divided into three groups (n=8/each group), namely, diabetic rats, diabetic rats treated with AS-IV at 5 and 10 mgkg(-1)d(-1), p.o., for 8 weeks. The normal rats were chosen as nondiabetic control group (n=8). The rats were sacrificed 10 weeks after induction of diabetes. AS-IV ameliorated albuminuria, renal histopathology and podocyte foot process effacement in diabetic rats. Renal NF-κB activity, as wells as protein and mRNA expression were increased in diabetic kidneys, accompanied by an increase in mRNA expression and protein content of TNF-α, MCP-1 and ICAM-1 in kidney tissues. The α1-chain type IV collagen mRNA was elevated in the kidneys of diabetic rats. All of these abnormalities were partially restored by AS-IV. AS-IV also decreased the serum levels of TNF-α, MCP-1 and ICAM-1 in diabetic rats. These findings suggest that AS-IV, a novel anti-inflammatory agent, attenuated DN in rats through inhibiting NF-κB mediated inflammatory genes expression. Copyright © 2013 Elsevier Ltd. All rights reserved.
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            Meta-analysis of the clinical value of Astragalus membranaceus in diabetic nephropathy.

            Weixin Wang, MINGXIN LI, Yong Q. Gu … (2011)
            Nowadays diabetic nephropathy (DN) has become a serious problem. Astragalus membranaceus is a traditional herb used for thousands of years in China and East Asia for kidney disease. In modern medicine, Astragalus shows significant renal protective effect in DN. We aimed to systematically review the randomized and semi-randomized control trials to ascertain its role in the treatment of DN. PUBMED, MEDLINE, Chinese journal full-test database (CJFD), Chinese biological and medical database were searched by computer and manual searching. Two assessors independently reviewed each trial. 25 studies comprising 21 RCTs and 4 CCTs were involved including 1804 patients (945 in treatment group and 859 in control group). Astragalus injection had more therapeutic effect in DN patients including renal protective effect (BUN, SCr, CCr and urine protein) and systemic state improvement (serum albumin level) compared with the control group. This study investigates the effect of Astragalus in DN patients. It suggests that although of unknown bioactive ingredients and mechanism of renal protection, the role of Astragalus in the treatment of DN can be disclosed and of profound significance. Copyright © 2010 Elsevier Ireland Ltd. All rights reserved.
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              Systematic review of the renal protective effect of Astragalus membranaceus (root) on diabetic nephropathy in animal models.

              Juqian Zhang, Xisheng Xie, Chen Li … (2009)
              Diabetic nephropathy (DN) has long been recognized as the leading cause of end-stage renal disease. Recent experimental studies have shown that Astragalus membranaceus (AM) (root) has an inhibitory effect on the oxidative stress that characterizes early DN. This systematic review assesses the efficacy and safety of AM (root), used as a single herb, in slowing the progression of DN in diabetic rat models. We conducted both an electronic search and a search by hand of randomized, controlled AM (root) treatment studies (including its effective components) focusing on animal models of DN. Two reviewers independently selected and assessed the studies. Among the 41 articles identified, 13 reports that fulfilled the inclusion criteria were included. Significant beneficial effects were observed in the AM (root) treated groups compared to controls regarding fasting blood glucose levels (standardized mean difference [SMD]: -2.86, 95% confidential interval (CI): -4.26, -1.46, P < 0.001), glomerular filtration rate (SMD: -3.36, 95% CI: -4.69, -2.03, P < 0.00001), urinary albumin excretion rate (SMD: -2.46, 95% CI: -3.75, -1.16, P = 0.0002), and thickness of the glomerular basement membrane (SMD: -3.51, 95% CI: -6.68, -0.34, P = 0.03). AM (root) and its effective components are effective in reducing fasting blood glucose and albuminuria levels, in reversing the glomerular hyperfiltration state, and in ameliorating the pathological changes of early DN in rat models.
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                Author and article information

                Journal
                Journal ID (nlm-ta): Endocrinol Diabetes Metab Case Rep
                Journal ID (iso-abbrev): Endocrinol Diabetes Metab Case Rep
                Journal ID (pmc): edm
                Journal ID (publisher-id): EDM Case Reports
                Title: Endocrinology, Diabetes & Metabolism Case Reports
                Publisher: Bioscientifica Ltd (Bristol )
                ISSN (Electronic): 2052-0573
                Publication date (Electronic): 1 September 2014
                Publication date (Print): 2014
                Volume: 2014
                Electronic Location Identifier: 140063
                Affiliations
                [1 ]Kyunghee-saeng Korean Medicine Clinic , Seoul, Korea
                [2 ]Seoul 365 Medical Clinic , Seoul, Korea
                [3 ]Department of Cardiovascular and Neurologic Diseases , College of Korean Medicine, KyungHee University , 1 Hoegi-dong, Dongdaemun-gu, Seoul, 130-702, Korea
                Author notes
                Correspondence should be addressed to S Kwon Email: kkokkottung@ 123456hanmail.net
                Article
                Publisher ID: EDM140063
                DOI: 10.1530/EDM-14-0063
                PMC ID: 4176648
                PubMed ID: 25298884
                SO-VID: c9b6008f-74f1-49bd-a02c-325642a91912
                Copyright © © 2014 The authors
                License:

                This work is licensed under a Creative Commons Attribution-NonCommercial-NoDerivs 3.0 Unported License.

                History
                Date received : 6 July 2014
                Date accepted : 12 September 2014
                Categories
                Subject: Novel Treatment

                Data availability:

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