Efficacy of acupuncture combined with Chinese herbal medicine for the treatment of chronic nephritis: A protocol for systematic review and meta-analysis.

BACKGROUND: Chronic nephritis is a common kidney disease that afflicts people worldwide. The disease has main manifestations of proteinuria, hematuria, edema, and hypertension that are associated with kidney-damaging processes that eventually lead to kidney failure. Traditional Chinese medicine involving combination treatment with herbal remedies and acupuncture has been shown clinically to alleviate chronic nephritis, although to date no systematic review of the efficacy of this combination treatment for this purpose has been reported, prompting this study. Here we conducted a systematic review and meta-analysis of published randomized clinical trials to scientific evidence and credible medical references supporting the clinical efficacy of this combination treatment when used to treat chronic nephritis. METHODS: We will search the following 8 electronic Chinese and English databases: Web of Science, PubMed, Cochrane Library, Embase, China Biomedical Literature Database, China National Knowledge Infrastructure, China Scientific Journal Database, and the Wanfang database. All electronic databases will be searched from inception to October 10, 2021. All statistical analyses will be performed using Review Manager Version 5.4 provided by the Cochrane Collaboration Network. RESULTS: The protocol for systematic review and meta-analysis will be applied to evaluate the efficacy of acupuncture combined with Chinese herbal medicine for the treatment of chronic nephritis. CONCLUSION: We plan to submit the results of this research to a peer-reviewed journal. INPLASY REGISTRATION NUMBER: INPLASY2021100051.

Administration of Lactobacillus reuteri Combined with Clostridium butyricum Attenuates Cisplatin-Induced Renal Damage by Gut Microbiota Reconstitution, Increasing Butyric Acid Production, and Suppressing Renal Inflammation.

Cisplatin-induced nephrotoxicity is associated with gut microbiota disturbance. The present study aimed to investigate whether supplementation of Lactobacillus reuteri and Clostridium butyricum (LCs) had a protective effect on cisplatin-induced nephrotoxicity through reconstruction of gut microbiota. Wistar rats were given different treatments: control, cisplatin (Cis), cisplatin + C. butyricum and L. reuteri (Cis+LCs), and C. butyricum and L. reuteri (LCs). We observed that cisplatin-treated rats supplemented with LCs exhibited significantly decreased renal inflammation (KIM-1, F4/80, and MPO), oxidative stress, fibrosis (collagen IV, fibronectin, and a-SMA), apoptosis, concentration of blood endotoxin and indoxyl sulfate, and increased fecal butyric acid production compared with those without supplementation. In addition, LCs improved the cisplatin-induced microbiome dysbiosis by maintaining a healthy gut microbiota structure and diversity; depleting Escherichia-Shigella and the Enterobacteriaceae family; and enriching probiotic Bifidobacterium, Ruminococcaceae, Ruminiclostridium_9, and Oscillibacter. Moreover, the LCs intervention alleviated the cisplatin-induced intestinal epithelial barrier impairment. This study indicated LCs probiotic serves as a mediator of the gut-kidney axis in cisplatin-induced nephrotoxicity to restore the intestinal microbiota composition, thereby suppressing uremic toxin production and enhancing butyrate production. Furthermore, the renoprotective effect of LCs is partially mediated by increasing the anti-inflammatory effects and maintaining the integrity of the intestinal barrier.

Targeting kidney inflammation as a new therapy for primary hyperoxaluria?

The primary hyperoxalurias (PHs) are inborn errors of glyoxylate metabolism characterized by endogenous oxalate overproduction in the liver, and thus elevated urinary oxalate excretion. The urinary calcium-oxalate (CaOx) supersaturation and the continuous renal accumulation of insoluble CaOx crystals yield a progressive decline in renal function that often ends with renal failure. In PH Type 1 (AGXT mutated), the most frequent and severe condition, patients typically progress to end-stage renal disease (ESRD); in PH Type 2 (GRHPR mutated), 20% of patients develop ESRD, while only one patient with PH Type 3 (HOGA1 mutated) has been reported with ESRD so far. Patients with ESRD undergo frequent maintenance (haemo)dialysis treatment, and finally must receive a combined liver-kidney transplantation as the only curative treatment option available in PH Type 1. In experimental models using oxalate-enriched chow, CaOx crystals were bound to renal tubular cells, promoting a pro-inflammatory environment that led to fibrogenesis in the renal parenchyma by activation of a NACHT, LRR and PYD domains-containing protein 3 (NALP3)-dependent inflammasome in renal dendritic cells and macrophages. Chronic fibrogenesis progressively impaired renal function. Targeting the inflammatory response has recently been suggested as a therapeutic strategy to treat not only oxalate-induced crystalline nephropathies, but also those characterized by accumulation of cystine and urate in other organs. Herein, we summarize the pathogenesis of PH, revising the current knowledge of the CaOx-mediated inflammatory response in animal models of endogenous oxalate overproduction. Furthermore, we highlight the possibility of modifying the NLRP3-dependent inflammasome as a new and complementary therapeutic strategy to treat this severe and devastating kidney disease.

Giuseppe Moscati: a man, a physician and a scientist.

The life of Giuseppe Moscati (1880-1927) as a man, as a physician and as a scientist may be framed within the cultural climate of Positivism, which spread over the last years of the 19th century and the beginning of the 20th Century. His activity contributed to patients' care improvement; in addition to meticulous drug regimens, he also prescribed a methodology of spiritual care, involving meditation and self-control as part of an holistic approach to healthcare. Our review deals with his published researches, highlighting the innovative findings on the juvenile diabetes treatment and extensive clinical changes consequent upon nephritis. This extraordinary man put considerable emphasis on primary care and holistic health in Italy, pioneering a new patient-centred, and holistic approach to medicine.

[Clinical controlled trial on chronic nephritis albuminuria treated with acupuncture and moxibustion at DONG's extra points, "Xiasanhuana"].

OBJECTIVE: Io compare the difference on the clinical efficacy in treatment of chronic nephritis albuminuria between acupuncture and moxibustion at "Xiasanhuang", DONG's extra points and benazepril hydrochloride so as to provide the effective therapeutic method for the treatment of chronic nephritis albuminuria. Methods One hundred and six cases of nephritis albuminuria were randomized into an acupuncture and moxibustion group and a western medication group, 53 cases in each one. In the acupuncture and moxibustion group, acupuncture and moxibustion were applied to "Xiasanhuang" (Tianhuang fuxue namely "shenguan", "Dihuang", "Renhuang"), once a day, the interval of 2 days once every 10 treatments. In the western medication group, benazepril hydrochloride was prescribed for oral administration, 5 to 10 mg each time, once a day. The treatment of 2 months made, one session in the two groups. After 1 session treatment, the clinical efficacy, red blood cell count (RBC) of urinary sediment, 24 h urine protein quantitation and creatinine clearance rate (Ccr) before and after treatment were observed in the two groups. RESULTS: The total effective rate was 84. 9% (45/53) in the acupuncture and moxibustion group, superior to 52. 8% (28/53) in the western medication group (P<0. 01). After treatment, RBC of urinary sediment and 24 h urine protein quantitation were reduced as compared with those before treatment (P< 0. 01, P<0. 05), and the results in the acupuncture and moxibustion group were lower than those in the western medication group (P<0. 05, P<0. 01). After treatment, Ccr in the acupuncture and moxibustion group was higher than that before treatment (P<0. 05) and higher than that in the western medication group (P<0. 05). Ccr was not different significantly before and after treatment in the western medication group (P>0. 05). CONCLUSION: Acupuncture and moxibustion at DONG's extra points (Xiasanhuang) reduce proteinuria and improve kidney, function in patients of chronic nephritis and the efficacy is better than that with benazepril hydrochloride.

[Effect of acupuncture on renal function and pathologic changes of kidney in rabbits with nephritis].

OBJECTIVE: To observe the effect of acupuncture on cationized bovine serum albumin (C-BSA) nephritis model in rabbits and to explore its mechanism. METHODS: Fifty rabbits were randomly divided into a blank group, a model group, a metoprolol group, a irbesartan group and an acupuncture group, 10 rabbits in each group. The model was established by ear vein intravenous injection with C-BSA. The positive control groups were treated by intragastric administrated with metoprolol and irbesartan, respectively. The acupuncture group was treated by acupuncture at "Fengmen" (BL 12) and "Shenshu" (BL 23). No interventions were added on the blank group and the model group. The changes of blood pressure (BP), heart rate (HR), plasma norepinephrine (NE), serum creatinine (Scr), blood urea nitrogen (BUN) and 24 hours urine protein (24 h UP) in rabbits at the time points of 3rd, 6th and 8th week of treatment were observed. RESULTS: After the model was established, the Scr of (194.30 +/- 20.09) micromol/L, BUN of (9.19 +/- 0.66) mmol/L and 24 h UP of (277.70 +/- 20.09) mg/24 h in the model group were all higher than the Scr of (66.03 +/- 4. 76) micromol/L, BUN of (4.11 +/- 0.71) mmol/L and 24 h UP of (14.28 +/- 1. 47) mg/24 h in the blank group (all P < 0.01), and the diffused mesenteria hyperplasia and the increase of intercapillary cells in the model group were showed in the pathological sections. After 3 weeks of treatment. The Scr of (99.82 +/- 9.29) micromol/L, BUN of (6.32 +/- 0.75) mmol/L and 24 h UP of (189.67 +/- 15.45) mg/ 24 h in the acupuncture group were all decreased significantly, furthermore, the decrease of BP, HR, NE were better than the other treatment groups (P < 0.05, P < 0.01). Except the level of 24 h up and HR at 8th week, other results were as same as the 3rd week. CONCLUSION: Acupuncture can improve the function of kidney, decrease the content of 24 h UP and the underlying therapeutic mechanism could be correlated with that acupuncture can lower excitability of sympathetic nerve and alleviate the renal pathological lesion induced by nephritis.

Mild electrical stimulation and heat shock ameliorates progressive proteinuria and renal inflammation in mouse model of Alport syndrome.

Alport syndrome is a hereditary glomerulopathy with proteinuria and nephritis caused by defects in genes encoding type IV collagen in the glomerular basement membrane. All male and most female patients develop end-stage renal disease. Effective treatment to stop or decelerate the progression of proteinuria and nephritis is still under investigation. Here we showed that combination treatment of mild electrical stress (MES) and heat stress (HS) ameliorated progressive proteinuria and renal injury in mouse model of Alport syndrome. The expressions of kidney injury marker neutrophil gelatinase-associated lipocalin and pro-inflammatory cytokines interleukin-6, tumor necrosis factor-α and interleukin-1ß were suppressed by MES+HS treatment. The anti-proteinuric effect of MES+HS treatment is mediated by podocytic activation of phosphatidylinositol 3-OH kinase (PI3K)-Akt and heat shock protein 72 (Hsp72)-dependent pathways in vitro and in vivo. The anti-inflammatory effect of MES+HS was mediated by glomerular activation of c-jun NH(2)-terminal kinase 1/2 (JNK1/2) and p38-dependent pathways ex vivo. Collectively, our studies show that combination treatment of MES and HS confers anti-proteinuric and anti-inflammatory effects on Alport mice likely through the activation of multiple signaling pathways including PI3K-Akt, Hsp72, JNK1/2, and p38 pathways, providing a novel candidate therapeutic strategy to decelerate the progression of patho-phenotypes in Alport syndrome.

Effect of transcutaneous electrical muscle stimulation and passive cycling movements on blood pressure and removal of urea and phosphate during hemodialysis.

BACKGROUND: Intradialytic exercise has been described to improve blood pressure stability and dialysis efficacy. However, comorbid conditions in the dialysis population often preclude the widespread use of active intradialytic exercise. Therefore, we investigated the effect of intradialytic transcutaneous muscle stimulation (TEMS) and passive cycling movements (PCMs) on blood pressure and dialysis efficacy in patients. STUDY DESIGN: Prospective, controlled, randomized, crossover investigation. SETTING & PARTICIPANTS: Ten patients were randomly allocated to TEMS, PCMs, or no intervention (NI) for 9 consecutive dialysis sessions. INTERVENTION: Participants were studied with NI, PCMs using a motor-driven ergometer, and bilateral TEMS of the leg musculature. Individual dialysis prescriptions were unchanged during the investigation. OUTCOMES & MEASUREMENTS: The effect of TEMS and PCMs on blood pressure and dialysis efficacy in patients was assessed. RESULTS: Mean blood pressure increased from 121/64 +/- 21/15 mm Hg with NI to 132/69 +/- 21/15 mm Hg (P < 0.001) during sessions with PCMs and 125/66 +/- 22/16 mm Hg (P < 0.05) during sessions with TEMS. Urea and phosphate removal during dialysis were significantly (P < 0.001) greater with TEMS (19.4 +/- 3.7 g/dialysis and 1,197 +/- 265 mg/dialysis) or PCMs (20.1 +/- 3.4 g/dialysis and 1,172 +/- 315 mg/dialysis) than with NI (15.1 +/- 3.9 g/dialysis and 895 +/- 202 mg/dialysis). Body weight, ultrafiltration, Kt/V, and increases in hemoglobin and albumin levels during dialysis did not differ among the NI, PCMs, and TEMS groups. LIMITATIONS: The study design does not allow extension of the findings to prolonged treatment. CONCLUSION: Future studies during longer observation periods will have to prove the persistence of these acute findings. Both TEMS and PCMs deserve future investigations in dialysis patients because they increase intradialytic blood pressure and facilitate urea and phosphate removal when applied short term.

Alternative therapies for vasculitis and proliferative nephritides: the role of cyclic AMP elevating agents.

Cytoprotection by E-prostaglandins, working by elevation of intracellular cyclic AMP, is a natural physiological mechanism. When agents that elevate cAMP are used in pharmacological regimens they have potent anti-inflammatory effects that could be used to good effect as adjuncts for the control of vasculitides/nephritides.

Acupuncture for immune-mediated disorders. Literature review and clinical applications.

Acupuncture activates the defense systems. It influences specific and nonspecific cellular and humoral immunities; activates cell proliferation, including blood, reticuloendothelial, and traumatized cells; and activates leucocytosis, microbicidal activity, antibodies, globulin, complement, and interferon. It modulates hypothalamic-pituitary control of the autonomic and neuroendocrine systems, especially microcirculation, response of smooth and striated muscle, and local and general thermoregulation. Immunostimulant points include LI-4, LI-11, ST-36, GB-39, SP-6, GV-14, BL-11, BL-20, BL-23, BL-24, BL-25, BL-26, BL-27, BL-28, and CV-12. Some, such as BL-47, are immunosuppressive. Antifebrile points include GV-14 and ST-36. Reactive reflex SHU points, MU points, and earpoints are useful in organic diseases. In immunomediated diseases, some or all of these points can be used with other points, especially local points and points of the major symptoms or points of the affected body part, area, function, or organ. Applications of acupuncture include treatment of inflammation and trauma; stimulation of tissue healing in burns, ulcers, indolent wounds, ischemia, necrosis, and gangrene; infections; postinfection sequelae; fever; autoimmune disease; allergies; anaphylaxis and shock; and treatment or prevention of side effects from cytotoxic chemotherapy and ionizing radiation. Acupuncture therapy may inhibit neoplastic cells. Examples of acupuncture use in immunomediated conditions in small animals are given.

[Physiotherapy in recurring urinary calculus formation and chronic inflammatory kidney and urinary tract diseases]. / Physiotherapie bei der rezidivierenden Harnsteinbildung und chronisch entzündlichen Nieren- und Harnwegserkrankungen.

Physiotherapeutic methods for supplementation of internal or urological treatment of chronic, inflammatory renal diseases and of the relapsing formation of urinary calculi are described. They serve to furthering of diuresis and flowing off, to supporting of defense infections by the body, to influence on the pain and take into consideration the regularity of the disturbed functional circles defaecation and thermoregulation. The short-wave therapy, abdominal water-dressing, partial bath wins increasing temperature and sauna-bath are described more in detail concerning the technique.