ROLE OF ACTIVATED CHARCOAL IN LIMITING THE PROGRESSION OF CHRONIC KIDNEY DISEASE IN ALBINO RATS

Abstract

Background: Chronic kidney disease (CKD) is characterized by impaired kidney function, progressive kidney damage, unbalanced gut microbiota and disrupted intestinal mucosal barrier function. The damaged intestinal barrier functions mediated mostly by urea, allows influx of toxic products such as indoxyl sulphate that cause systemic inflammation. Activated charcoal is a universal antidote for the majority of poisons. Activated charcoal was suggested as a supplementary treatment for patients with CKD to remove waste products such as urea, indoxyl sulphate and other toxins. Objectives: This study was designed to investigate the possible role of activated charcoal in limiting the influx of intestinal bacterial toxins to systemic circulation to limit progression of CKD in albino rats. Material and Methods: Forty male white albino rats were divided into 4 equal groups. Sham operated control group (Group I): rats in this group were subjected to all steps of 5/6th nephrectomy except for kidney removal and sacrificed after 6 weeks, 5/6th nephrectomised group (Group II): were subjected to 5/6th nephrectomy operation, early charcoal treated 5/6th nephrectomised group (Group III ): were subjected to 5/6th nephrectomy operation and charcoal treatment (4g/kg/day) started immediately after operation for 6 weeks, and late charcoal treated 5/6th nephrectomised group (Group IV): were subjected to 5/6th nephrectomy operation and charcoal treatment started 2 weeks after operation continued for 4 weeks. Body weight and arterial blood pressure were measured before scarification after 6 weeks. Level of creatinine, urea, indoxyl sulphate and C- reactive protein were determined in the serum. Histological studies of pieces of terminal ileum and colon stained hematoxylin and eosin were done. Renal fibrosis index was assessed in remnant kidney stained with Masson Trichome. Results: Group II had elevated serum level of urea, creatinine, indoxyl sulfate and C- reactive protein, colonic erosions and renal fibrosis compared to control group. Group III showed decreased level of serum creatinine, urea, indoxyl sulphate and C-reactive protein with partial restoration of the colonic mucosal integrity and reduction in renal fibrosis. Group IV had altered serum creatinine, urea and C- reactive protein but not serum indoxyl sulphate. Arterial blood pressure elevated in all studied groups compared to control group and was not affected by charcoal administration. Conclusion: Activated charcoal has the ability to limit progression of CKD and the fibrotic changes in the kidney as well as to limit the associated intestinal barrier disruption, and the early therapy was more significant compared to late interference.