Radix and Rhizoma Rhei (RR) has the effect of alleviating hypertrophy of kidney and lowering the hyperfiltration of glomeruli.The authors tr
Radix and Rhizoma Rhei (RR) has the effect of alleviating hypertrophy of kidney and lowering the hyperfiltration of glomeruli.The authors treated 32 cases of early stage diabetic nephropathy by adding RR to the routine treatment and good effect was obtained.The study is reporte as follows.
Sixty-two in-patients of the authors’ hospital hospitalized from Oct.1992 to Oct.1994 were enrolled and divided randomly into RR group and control group.Among the 30 cases in the control group 9 were male and 21 female,aged 20~75 years,with history of diabetes mellitus (DM) of 12 months to 9.4 years,5.3 years in average,and histort of diabetic nephropathy (DN) of 4.5 months to 9.4years,4.8 years in average,4 cases among them were insulin dependent and 26 cases were non-insulin dependent.In the 32 patients of the RR group,8 were male and 24 female,their age ranging from 21 to 75 years,with DM history of 14 months to 9.5 years,5.6 years in average, DN history of 3.9 ,months to 9.5 years,5.0 years in average,4 were insulin dependent and 28 non-insulin dependent.
All the patients fit in with the following diagnostic standard :(1) Having DM history definitely or with fasting blood glucose level>7.8 mmol/L or/and with blood glucose level>11.1 mmol/L for once only is enough (The diagnostic standard of DM stipulated by the World Health Organization,1980).(2) With diffuse enlargement of bilateral kidney by B-ultrasonic scanning,creatinine clearance rate>120 ml/min,or postkinetic urinary microalbumin excretion increase,or persistene micro-albuminuria.(3) With proteinuria examination showing negative result and renal function normal.Treatment
Hypoglycemic agent was given to both groups by administering 2.5~10mg of euglucan twice every day,and regular insulin injections were given to 13 cases (6 cases in the control group and 7 in the RR group) subcutaneously 3 times per day (12 u in the morning,8 u at noon and 12 u at evening) before meals.The following drugs were withdrawn: hypolipemic agent,diuretic,kidney protecting drug,angiotensinase inhibitor and β-receptor blocking agent.To the RR group,the RR in powder form was given additionally,5g each time twice a day,orally with warm water.Parameters of Observation
The following parameters were observed before and after 3 months of treatment.(1) Size of bilateral kidney estimated by B-ultrasonic scanning (average value of 3 times of examination). (2) Creatinine clearance rate (CCr) by calculating from creatinine levels in blood and urea,with the formula:
24 h Urea creatinine (mmol/L)
Blood creatinine (μmol/L)
(3) Urea microalbumin (UMA) excretion and β2-microglobulin (β2-mG) determined with radioimmunoassay.(4) 24 h urea protein determined by sulfosalicylic acid-sodium sulfate turbidimetric analysis.Statistical Analysis
Data were dealt by homogeneity test of variance, and comparison of effects between groups was analysed with t-test.
Table.Changes in Parameters of the Two Groups (x±s)
Group Size of Kidney CCr UMA Ureaβ2-mG Urea Protein
──────── ────── ───── ────── ─────
(Length×Width,cm²) (ml/min) (μg/min) (mg/L) (g/24h)
Control Pre-t. 13.68±1.25×7.51±0.72 152.83±8.35 58.26±43.00 1.67±0.07 0.45±0.13
(30) Post-t 13.46±1.25×7.52±0.73 145.00±8.19 54.30±38.20 1.69±0.07 0.42±0.13
RR Pre-t. 13.57±1.26×7.46±0.70 152.91±8.38 58.17±43.40 1.71±0.06 0.44±0.14
(32) Post-t. 11.84±1.49×5.64±0.65﹡ 112.85±5.82﹡﹡ 20.35±13.80 ﹡﹡ 1.62±0.06 0.33±0.07﹡﹡
Notes:* P﹤0.05,﹡﹡P﹤0.01,compared with pre-treatment and post-treatment of the control group; the numeral in bracket is the number of cases
As shown in the table,before treatment,the parameters of the two groups were not different significantly (P﹥0.05). After treatment,in the RR group,the CCr got lowered,the enlarged kidney shrunken and the urea protein excretion reduced. Compared with before treatment or with the control group, the differences were significant (P﹤0.05 or 0.01).However,the change of ureaβ2-mG excretion after treatment in the RR group was insignificant (P﹥0.05).
Since XU Xi-yan,et al applied RR,in the 60’s,on the basis of supporting body resistance in treating azotemia with definite effectiveness,other researchers have found that good effect could also be reached by applying RR without inducing diarrhea (Zhejiang Journal of TCM 1982;17(5):212), suggesting that RR might realize its effect through other way than inducing diarrhea.Recent researches showed that RR could lower the hyper-filtration of glomeruli, inhibit markedly the proliferation of mesenteric cells,and be of an antagonistic effect against some cellular factors such as interleukin-6.It is shown,therefore, that RR could influence the pathogenic mechanism of nephropathy in different aspects. RR has been affirmed by the 4 th session of National Conference of Nephropathy as an important medicine for delaying progress of chronic renal failure.Based on the above-mentioned effects of RR, the authors used RR in treatment of early stage DN,and results showed that its curative effect was markedly superior to that of medicines used for the control group.In the RR group, the urea protein significantly decreased,CCr lowered and enlarged kidney shrank in different degrees,while in the control group these changes were not evident. Judging from this,we can say RR acts mainly on the mesenteric tissue of glomeruli, the proliferation of which (mesenteric cells and stroma) plays a very important role in pathogenesis of glomerulosclerosis.RR could inhibit the proliferation of mesenteric tissue, and suppress the effects of auto-,para- and intra-cellular secretion of some cellular factors (particularly the sclerotic factor) on glomeruli, so as to alleviate the glomerulosclerosis, and delay the process of kidney damage.
Sinceβ2-mG is filtrated by glomeruli, and absorbed at proximal tubule, its excretion in urea would be increased when there is injury of proximal tubule, and so it is recognized as a sensitive criterion indicating damage of proximal tubules. After treatment, theβ2-mG level of the two groups were similar, without significant difference, suggesting that the influence of RR on proximal tubule of early stage DN patients was truly not much.
In the therapeutic course, there were 3 cases in the RR group who manifested mild diarrhea after taking RR .Among them, 1 case had a history of chronic colitis, no special treatment was appoied to them, and the therapy was not affected by the diarrhea.