Basic study and clinical practice of Kampo medicines in chronic kidney disease (CKD): chronic glomerulonephritis and nephrosclerosis
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概要
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Chronic glomerulonephritis and nephrosclerosis are major causes of the renal failure after diabetic nephropathy. Steroids and immunosuppressants are often used to the patients with active type of glomerulonephritis; however, long term-use of these drugs occasionally induces undesirable side effects. It is generally accepted that angiotensin converting enzyme inhibitors and angiotensin II receptor blockers are beneficial to protect renal injury in CKD. The availability of recent evaluation methods in basic study and clinical practice has revealed the efficacy and usefulness of traditional Kampo medicines for CKD. The Kampo formula saireito ameliorated proteinuria, mesangial proloferation, and extracellular matrix accumulation in experimental rat mesangioproliferative glomerulonephritis (MsPGN). Perilla suppressed proteinuria, proliferation of glomerular cells, serum levels of IgA, glomerular IgA and IgG depositions in HIGA mice. Uninephrectomized rats with anti-Thy-1 nephritis, an irreversible MsPGN model, shichimotsukokato suppressed elevation of systolic blood pressure and glomerular hypertrophy. Saireito has been applied to nephrotic syndrome, and occasionally induces rapid response to the therapy. Saireito has been reported to be effective in reducing proteinuria in IgA nephropathy with focal mesangial proliferation in a prospective controlled study. In a retrospective clinical evaluation, saibokuto reduced proteinuria and hematuria as well as an anti-platelet agent dilazep in mildly active IgA nephropathy accompanied with frequent episodes of upper respiratory infection. Recently, re-evaluation and application of shichimotsukokato in CKD has begun. In CKD patients of nephrosclerosis, with elevated creatinine levels, treatment of shichimotsukokato following angiotensin II receptor blockers furthermore reduced blood pressure, and induced reduction of serum creatinine levels. Kampo medicines may have the potential to improve CKD, when added to the standard treatment. The challenges that remain are to identify the subset of CKD conditions with good response to Kampo medicines.
- 和漢医薬学会の論文
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