Journal of Nephrology & Therapeutics

Increasing concerns today about the beneficial effects of herbal medicines necessitate establishing a proper system allowing us of having a standardized herbal medicines with consistent quality that have high reliability in clinical trials and therapeutic use. This study represents an ideal complete project that aimed to introduce and apply such system through systematic oriented research that ultimately lead to introduce a herbal-based therapeutic agent that could be used to fill the therapeutic gap in disease management. Orthosiphone stamineus is being used in south East Asia in the management of different aliments including kidney problems, hypertension and diabetes. This herb was chosen by the Malaysian ministry of health to introduce and apply the systematic approach of drug discovery to propose a quality consistent well-defined herbal extract that could be introduced ultimately as a therapeutic agent in the management of nephrolithiasis and to act as renoprotective agent. Kidney stone (Nephrolithiasis) was considered as one of the important factors that lead to the blockage of urine passage out of the body (urinary obstruction) and eventually acute kidney failure. Nephrolithiasis is multi-factorial disease that involves metabolic and non-metabolic factors. Moreover, geographical location plays a role in the prevalence of nephrolithiasis in different parts of the worlds that was higher than the role played by ethnic variations. This role can be represented in the presence of variance metabolic factors that contribute to disease pathogenesis. Consequently, this has a significant reflects on the treatment approach and recurrence preventive measures in different locations. Nephrolithiasis treatment goes through two approaches, control symptoms and then get rid of the stone through known procedures. However, in conjunction with the different factors that lead to nephrolithiasis, no single medicine was available so far to cover all or even most of the contributed factors. This creates a gap in nephrolithiasis management, especially stone recurrence. Different models have been postulated to mimic the pathogenesis of nephrolithiasis. Some of these models gathered at the concept of insulting kidney with one of the chemicals that lead to the stone formation. Among these models, ethylene glycol which serves as one of the important models that reflect the effectiveness of different chemicals and naturals agents in protecting kidney from total calcification and renal failure. Different models have been used in our study to elaborate the diuretic, hypouricemic and anti-lithiatic effects of standardized extract of O. stamineus leaves and its role in kidney protection. Mechanisms were discussed and the responsible components were identified

Diabetes is no doubt one of the most difficult health problems of the 21st century. It is a leading cause of CKD worldwide and its increasing prevalence may explain much of the increase in prevalence of kidney failure. Diabetic patients with chronic kidney disease present an additional risk for the presence of the glycemic variability due to insulin resistance. Several studies indicated that this glycemic variability seems to be an independent cardiovascular risk factor and has more deleterious effects on endothelial function compared to sustained hyperglycemia, especially due to oxidative stress activation. Glycated hemoglobin (HbA1c) is considered the gold standard for the assessment of glycemic control. In CKD patients, there are many factors which could lead to false and misleading values of HbA1c. Among the factors that lead to falsely low HbA1c values are: reduce erythrocytes lifespan, hemolysis, iron deficiency, repeated transfusions and erythropoiesis stimulating agents. Falsely high HbA1c levels are induced by hemoglobin carbamylation. Also HbA1c is not able to identify glycemic variability. Therefore it is necessary to identify methods to assess glycemic excursions in CKD patients. Commonly used antidiabetic drugs are renally excreted and have a prolonged half-life in patients with CKD, predisposing them to the risk of episodes of hypoglycemia. Furthermore, the predialysis glycemic control is also a determinant of both mortality and progression of diabetic complications for patients on continuous ambulatory peritoneal dialysis (CAPD). Continuous glucose monitoring system may represent a useful tool that allows glycemic variability quantification and also efficient discrimination between the sustained chronic hyperglycemia and acute glucose fluctuations. The use of CGMS gives potential insights both into overall glycemic control (mean glucose) and variability of such control over the full 24-hour period.

Renal ischemia-reperfusion (I/R) is a major cause of acute kidney injury. The pathogenetic mechanisms underlying I/R injuries involve oxidative stress and apoptosis. Competitive antagonists of type I angiotensin II receptor (AT1R) are well known antihypertensive drugs with some antioxidative potential. This study aimed to investigate the effects of Losartan on renal I/R injury comorbid with hypertension in an in vivo rat model. Experiments were performed on anaesthetized adult male spontaneously hypertensive rats (SHR). The right kidney was removed and the renal ischemia was performed by clamping the left renal artery for 40 min. SHR groups received losartan or vehicle in the femoral vein 5 min during and 175 min after the period of ischemia. All biochemical parameters were measured and kidney tissue was analysed morphologically and immunomorphologically applying Bax and Bcl-2 antibodies 24 hours after ischemia. Losartan treatment significantly increased creatinine clearance (p<0,001; ARF+LOS vs. ARF), attenuated TBARS level (p<0.01; ARF+LOS vs. ARF) and increased catalase activities (p<0.05; ARF+LOS vs. ARF) after I/R injury. Moreover, bax expression was significantly lower in losartan-treated rats. Tubular dilatation was smaller or even absent in some kidney specimens. In the cortico-medullary zone, tubular necrosis was reduced. Losartan protects SHR kidney from I/R injury by suppressing oxidative stress that results in cell apoptosis reduction and increasing of glomerular filtration. Therefore, blockade of AT1R may have beneficial effects in hypertensive patients who have developed ischemic acute kidney injury.

During the 1990s, despite the enthusiasm of transplant professionals and legal regulation for cadaveric donation based on presumed consent, the organ donation and transplantation rates in Croatia were very low. In 1998, a resolution on fostering organ transplantation was adopted and actions were implemented by the Ministry of Health. The most important was the appointment of the national transplant coordinator, establishment of a well-organized and highly efficient transplant coordinators network and international collaboration. Hospital based coordinators have become intensive care specialists who went through the internationally recognized training courses. They introduced a proactive approach to early identify all potential donors and apply standardized protocols for optimal donor management. These joined efforts resulted in a tremendous increase of the organ donor rate in Croatia and a progressively shortening waiting time for organ transplantation. Although the prevalence of patients on renal replacement therapy increased by 49% (to 980 p.m.p.) between 2001 and 2011, a reduction in the percentage of patients on hemodialysis treatment by 18% was possible due to the increase in the percentage of patients with a functioning kidney transplant from 15 to 34%. Average waiting time for kidney transplantation decreased to less than two years, and average waiting time for pancreas and heart transplantation to one and two months, respectively. In 2012, Croatia became the leading country in the world by increased deceased donation and transplantation rates, with 34.2 utilized donors p.m.p. (157 actual donors, 36.5 p.m.p.) and the highest annual rate of transplanted organs (93.2 p.m.p.).

Portulaca oleracea is an important drug of Unani medicine described to be effective in renal diseases. In the present study therefore the nephroprotective effect of Kurfa was studied in experimentally induced nephrotoxicity by the administration of gentamycin (80 mg/ kg) and doxorubicin (7.5 mg/kg) in different groups albino rats. The hydroalcoholic extract of Khurfa in the dose of 230 mg/kg (group A) and 390 mg/kg (group B) was administered orally for 14 days to the animals pretreated with gentamycin and doxorubicin. The nephroprotective effect was evaluated on the basis of biochemical estimation of serum creatinine, blood urea and urine protein in gentamicin treated group and serum creatinine, blood urea, serum cholesterol, serum albumin and urine protein in the group treated with doxorubicin. Histopathological study of the kidneys was also done to confirm the results. The findings were compared with negative and plain control groups using one way ANOVA and Tukey Kramer multiple comparison test. The test drug in gentamicin induced nephrotoxicity group produced significant effect as the concentration of urea and serum creatinine decreased significantly (p<0.01). The proteinuria also reduced significantly. The test drug in doxorubicin treated group was found to decrease blood urea (p<0.01) and serum cholesterol (P<0.001) in pretreated group at higher dose level. In post-treated group the drug was effective at both the doses however the higher dose was comparatively more efficacious. Urinary protein was also found decreased significantly. Histopathological studies demonstrated dose dependant effect of the test drug in both the pre and post treated groups. The study demonstrated that Khurfa (Linn.) possesses significant nephroprotective effect against gentamicin and doxorubicin induced nephrotoxicity.