st. lukes grand rounds

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Travis Spire-Sweet, LAc, Dipl. OM.

Traditional Chinese MedicineAnd Chronic Kidney Disease

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Overview

Cultural Development of Nephrology

Aristolochic Acid and Chinese Herbal Nephropathy

Nephrotoxic over the counter herbs

Traditional Chinese medicine’s treatment of kidney disease Acupressure Acupuncture Single Herbs Formulas

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Cultural Development of Nephrology

HuangDi NeiJing – Yellow Emperors Classics Of Medicine

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Cultural Development of Nephrology

Egyptian Mummies: Kidneys and Hearts only organs saved

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Cultural Development of Nephrology

Mayan culture’s use of herbs and stones in kidney ailments

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1,600 women received this particular weight loss therapy

100 ended up having cancer or ESRD

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14Nephrotoxic Over the Counter Herbs

Pyrrolizidine Alkaloid Containing Species6

• Borage (Borago officinalis) • Comfrey (Symphytium species), • Coltsfoot (Tussilago farfar), • Liferoot (Senecio aureus).2

Chinese herbs that contain pyrrolizidine alkaloids are:• Kuang Dong Hua (Flos Tussilaginis farfarae),• Pei Lan (Herba Eupatorii fortunei), • Qian Li Guang (Senecio scandens), • Zi Cao (Radix Arnebiae seu Lithospermi)3

15Nephrotoxic Over the Counter Herbs

Herbal Aquaretics2

• Tian Men Dong (Tuber Asparagi cochinchinensis) • Gan Cao (Radix Glycyrrhizae uralensis), • Horseradish(Radix Armoracia rusticana), • Juniper berry(Fructus Juniperus communis), • Lovage root (Radix Levisticum officinale), • White sandalwood (Santalum album), • Watercress (Nasturtium officinale)

16Nephrotoxic Over the Counter Herbs

Licorice (Radix Glycyrrhizae uralensis) 2,4,5

Commonly given in formulasand as a single herb.

Excessive licorice consumptioncan lead to pseudoaldosterism

17Nephrotoxic Over the Counter Herbs

Ephedra (Herba ephedra) 2,4,7

Increases blood pressure

Potentially contributes to kidneystones

18Nephrotoxic Over the Counter Herbs

St. John’s Wort (Hypericum perforatum) 4,8

Competes with immunosuppressiveDrugs

Also changes how immunosuppressivedrugs are broken down and theirbyproduct

19Traditional Chinese medicine’s treatment of kidney disease

Acupressure

Acupuncture

Single Chinese Herbs

Herbal Formulas

Treatment Modalities:

20Acupressure

Acupressure is the manual administration of force to an acupuncture point or channel by a finger, hand, elbow, or other instrumentation.

21Acupressure

Fatigue and Depression 9,10

Insomnia 11,12,13,14

Pruritus 15,16

Diabetic Neuropathy 17

Acupressure benefits with kidney disease:

Acupuncture

Acupuncture

Acupuncture

27Acupuncture

Acupunctures benefits with kidney disease:

Decrease Blood Pressure18

Slows Progression of Kidney Disease19,20,21

Relieves Pruritus22

Ameliorates Diabetic Neuropathy23

Decreases sympathetic nerve activityIn kidney24,25,26

Pain Management27,28

Alters Renal Blood Flow29,30

28Single Chinese Herbs

Cordyceps Sinensis

Tryptergerium Wilfordii

Salvia Miltiorrhiza

Radix et Rhizoma Rhei

Radix Astragali

29Cordyceps sinensis

Inhibits Inflammatory Pathway of Kidney Disease31

Prevents Nephrotoxicities31,32,33,34,35,36,37

Slows Progression of Chronic Kidney Disease38,39,40

Ameliorates Damage from ischemia reperfusion41,42,43

30Tryptergerium Wilfordii

• Acts a potent Immunosuppressant

• Decreases Proteinuria in multiple forms of chronic kidney disease 48

Nephrotic Syndrome 44,45

IgA Nephropathy 46

Potential therapy for renal transplant 47

31Salvia miltiorrhiza

Decreases proteinuria, glomerular sclerosis, and tubular interstitial lesions by inhibiting TGF-Beta 49,50,51,52

Lowers BUN and Scr in CKD patients49,50,51,52

Inhibits ROS by Increases serum SOD and catalase49,50,51,52

Lowers blood pressure, via ACEi, atrial natriuretic peptide, eNOS 53,54

Increases renal blood flow51

Acts as a xanthine oxidase inhibitor, prevent gout55

32Salvia miltiorrhiza

Lessen diabetic nephropathy after onset56

Prevent kidney stone formation57

33Radix et Rhizoma Rhei

• Protective effect with CKD patients49,50,52,58

Decrease Proteinuria

Decrease Scr

Decrease severity of glomerulosclerosis

Decrease monocyte infiltration in remnant glomeruli

Inhibits proliferation of mesangial cells

34Radix et Rhizoma Rhei

Increases survival rate of chronic kidney disease patients52

Prevents progression of renal disease when combined with angiotensin inhibitors59

Decreases adverse effects of dialysis (pruritus) 52

35Radix Astragali

Decreases proteinuria 52,60,61,62

Anti-Diabetic (decreases fasting serum glucose, increases albumin levels) 52,61Increases Creatinine Clearance, decrease Scr62

Increase hemoglobin62

Decreases blood pressure62

36Chinese Herbal Formulas

Chai Ling Tang

Jin Gui Shen Qi Wan

Dang Gui Bu Xue Tang

37Chai Ling Tang

Reduces autoimmune response in diseases such as rheumatoid arthritis 66

Reduces chances of acute rejection in kidney transplant. Every herb in this formula is important in it’s anti-rejection capability 84

Reduces proteinuria in acute glomerulonephritis (Lupus and IgA) 49,63,64,65

Decreases proliferation of mesangial cells and inhibits progression of renal damage during acute kidney diseases 49,63,64,65

Alters immune function – prevents alloimmune and autoimmune spontaneous abortion 67

38Jin Gui Shen Qi Wan

Decreases Renal Oxidative Stress and dyslipidemia 68,69,70,71,72

Decreases Blood Pressure 73,74

Ameliorates diabetic nephropathy 75,76,77,78,79,80,81,82,85

Decrease renal hypoxia damage 83

39Dang Gui Bu Xue Tang

Decreases glomerular tubulointerstitial injury via inhibition of TGF-Beta86

Decreases Extra Cellular Matrix precursors via activation of VEGF 87

Increases renal protective effect of enalopril88

Decreases vasopressin does not act as a ACEi 88

Induces EPO expression via HIF pathway 89

Decreases hyperlipidemia and proteinuria in nephrotic syndromes50,90

Unique preparation accounts for bioactivity of formula (5:1) 91,92

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APOL-1 Genetic Mutation 93,94,95

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