The efficacy and safety of Chinese herbal medicine combined with ACEI/ARB fortreatment of incipient diabetic nephropathy： Ameta-analysis

Objective： This meta- analysis evaluated the efficacy and safety of Chinese herbal medicine （CHM） combined withangiotensin-converting enzyme inhibitors （ACEIs） and/or angiotensin-receptor blockers （ARBs）for treatment ofincipient diabetic nephropathy（IDN）. Methods： Nine data bases were searched for randomized controlled trials ofChinese herbal medicine（CHM） and ACEI/ARB for treatment of IDN. Included articles were published betweenJanuary2006 and December 2016. All studies were divided into prescriptions containing both Astragali Radix andRehmanniae Radix （i subgroup）, Astragali Radix（Huangqi） or Rehmanniae Radix（Dihuang） （ii subgroup）, neitherAstragali Radix nor Rehmanniae Radix （iii subgroup）. Review Manager 5.3 was used for subgroup analysis.Results： In total, 28 RCTs with 2017 patients were included. The results showed 1）the urinary albumin excretionrate （UAER） can be reduced significantly using CHM with ACEI or ARB for treatment of IDN compared to ACEIor ARB alone, and reduction of the UAER of the i subgroup was superior to that of the other two subgroups;2）serum creatinine （Scr） levels can be reduced significantly using CHM combined with ACEI or ARB, andreduction of Scr in the ii subgroup was superior to that in the iii subgroup; 3）reduction of BUN in group A was notbetter than that in group B. Conclusion： In summary, CHMs combined with ACEI/ARB can decrease UAER andScr significantly compared to the use of ACEI/ARB during IDN treatment. The effect was more significant in theCHM group containing Astragali Radix or Rehmanniae Radix. The application of Astragali Radix and RehmanniaeRadix should be emphasized in third stage diabetic nephropathy.

Effects of Astragalus Membranaceus on Urinary Endothelin in Patients with Incipient Diabetic Nephropathy

Objective: To investigate the effects of Astragalus membranaceus on patients with incipient diabetic nephropathy( IDN).Methods: Forty patients with IDN were randomly divided into two groups. The twenty cases in the treated group (Group A) were treated with Astragalus membranaceus injection 20 ml/d (equivalent to Astragalus membranaceus 40 g) in addition to conventional therapy, whereas the 20 cases in the control group(Group B) were treated only with conventional therapy. The levels of urinary endothelin (UET), and albumin were measured before and after treatment. Blood glucose and glycosylated hemoglobulin levels were also measured.Results: After four weeks therapy, the levels of UET and urinary albumin excretion rate. (UAER) in Group A were 39.8 ± 12.7 pg/12h and 37.3 ± 30.4 μg/min respectively as compared with Group B (51.2±12.8pg/12h, 79.6 ± 35.8μg/min respectively, P<0.05, P<0.01 respectively). Compared with the pretreatment level, the UET and UAER values declined significantly in Group A(P< 0.01), but not in Group B(P>0. 05). One month after stopping use of Astragalus membranaceus, the levels of UET and UAER in Group A were still lower than those in Group B, and the difference in the two groups was statistically significant.Conclusion: Astragalus membranaceus might reduce UET and UAER in patients with IDN.

Clinical Study on Treatment of Incipient Diabetic Nephropathy by Integrated Traditional Chinese and Western Medicine

Objective: To explore the curative effect of integrated traditional Chinese and western medicinal (TCM-WM) therapy on incipient diabetic nephropathy (DN).Methods: One hundred patients with incipient DN were randomly divided into two groups, the treated group (50 cases) was treated with TCM-WM therapy, which was carried out by using Jiangtang Jianshenling (JTJSL) capsule, a Chinese preparation for supplementing Qi and nourishing Yin, on the basis of effectively controlling blood glucose with western medicine. The 50 patients in the control group were treated with western medicine alone. The course of treatment was three months. Changes of symptoms, signs and related laboratory parameters were observed before and after treatment.Results: The total effective rate in the treated group was 90% while that in the control group 58%, the difference between the two groups was significant (P<0.05). The related parameters including 24 hrs urinary albumin excretion, blood sugar, microalbuminuria, blood and urine β2-microglobulin, blood lipids and hemorrheologic parameters were all improved after treatment in the treated group (P<0.05 or P<0.01).Conclusion: The curative effect of TCM-WM was better than that of western medicine alone in treating incipient DN.