Treatment Of Diabetic Nephropathy Research Articles

Network Meta-analysis of Qi-supplementing and Yin-nourishing Chinese patent medicines in treatment of early diabetic nephropathy

This study aimed to evaluate the efficacy of Qi-supplementing and Yin-nourishing Chinese patent medicine in the treatment of early diabetic nephropathy(DN) by network Meta-analysis to explore the Chinese patent medicine with optimal efficacy and provide references for preventing renal deterioration and delaying the progression of early DN. Eight databases, including CNKI, Wanfang, VIP, SinoMed, PubMed, EMbase, Cochrane Library, and Web of Science, were searched for clinical randomized controlled trial(RCT) of Qi-supplementing and Yin-nourishing Chinese patent medicines in the treatment of early DN. After the literature mee-ting the inclusion criteria was screened, the quality of the literature was evaluated using the Cochrane risk-of-bias tool, and network Meta-analysis was performed using the BUGSnet package in R 4.2.1. Seventy-two research articles with a sample size of 6 344 cases were included, involving eight Chinese patent medicines and seven outcome indicators. The results of the network Meta-analysis showed that(1)in terms of improving urinary albumin excretion rate(UAER), Chinese patent medicines combined with conventional treatment were superior to conventional treatment, and Qiyao Xiaoke Capsules + conventional treatment was optimal.(2)In terms of reducing serum crea-tinine(Scr), Bailing Capsules + conventional treatment had superior efficacy.(3)In terms of reducing 24-hour urine total protein(24hUTP), Shenyan Kangfu Tablets + conventional treatment and Jinshuibao Capsules + conventional treatment had equivalent efficacy, and Shenyan Kangfu Tablets + conventional treatment was superior.(4)In terms of improving fasting blood glucose(FBG), Shenyan Kangfu Tablets + conventional treatment had superior efficacy.(5)In terms of improving total cholesterol(TC), Qiyao Xiaoke Capsules +conventional treatment had superior efficacy.(6)In terms of reducing triglyceride(TG), Bailing Capsules + conventional treatment had superior efficacy.(7)In terms of safety, the occurrence of adverse reactions was reported in seven interventions, but due to the large clinical heterogeneity, the quantitative analysis could not be performed. Overall, Qi-supplementing and Yin-nourishing Chinese patent medicines combined with conventional treatment were superior to conventional treatment alone in the treatment of early DN. The results showed that Qi-supplementing and Yin-nourishing Chinese patent medicines combined with conventional treatment had good clinical efficacy, and they could significantly reduce renal function indicators such as UAER, Scr, and 24hUTP, and reduce blood sugar and blood lipid, which can provide evidence-based support for the treatment of early DN. However, due to the differences in the quantity and quality of the included research articles, large-sample, multi-center, high-quality studies are still needed for further verification.

DoE Enabled Development and In-Vitro Optimization of Curcumin-tagged Cilostazol Solid Nano Dispersion

Background: Diabetes is a prevailing disease worldwide and its complications are also hazardous including nephropathy. Drug available to treat Diabetic Nephropathy (DN) faces bioavailability issues related to solubility and absorption of drugs. Cilostazol (CLT) is a BCS class II drug that is poorly water-soluble which affects its therapeutic efficacy. CLT reduces reactive oxy-gen species (ROS) increased in DN. Curcumin (Cur) is also hydrophobic but Cur has many therapeutic efficacies like anti-inflammatory and antioxidant properties that help for the treatment of DN. Objective: The objective of the current study was to develop and optimize the Cilostazol Solid Dis-persion Nanoparticle (SDN) to improve the bioavailability of the drug by tagging it with Cur by us-ing PVP VA S 630 as polymer and Poloxamer 407 as surfactant. Method: Different formulations were developed using the emulsion solvent evaporation method, PVP VA S 630 as the hydrophilic polymer, and Poloxamer 407 as a surfactant. Two-factor, three-level Box-Behnken Design (BBD) was used for statistical analysis of the selected process variable's main effect and interactive effect on the response. Curcumin tagging was also done for the entire batches. Nanoparticles were characterized by FT-IR spectroscopy, DSC, Particle size, Zeta poten-tial, Drug entrapment efficiency, Solubility, and % CDR studies. Results: Among the 17 different formulations (CLT1-CLT 17), with a solubility of 39.5 μg/ml, a % CDR of 99.55, a typical particle size of 219.67 nm with a PDI of 0.258, entrapment efficiency of 73.47%, and a -10.6 mV of Zeta potential, CLT-15 was optimized. To determine CLT and curcu-min, the simultaneous UV calibration method was created. Overall, the DSC study indicated the amorphous nature of the Nano Dispersion, which in turn means the successful entrapment of the CLT in the Nano Dispersion matrix. TEM images also confirmed the spherical nanoparticles. The optimized batch of drugs tagged with curcumin was compared with the plain drug Solid Dispersion Nanoparticles. Conclusion: Together with the molecules of curcumin, the solid nano dispersion of CLT was pro-duced, which will add to the benefits of the management of Diabetic Nephropathy. In the current study, we underline the importance of utilising both API and phytochemicals in the treatment of Di-abetic Nephropathy, and we anticipate further basic research or clinical trials to support innovative treatments. It is possible to use these matrix-forming polymers for active ingredients with poor sol-ubility, whether they are natural or synthetic. It has also been demonstrated that these carriers (PVP VA S 630 & Poloxamer) increase the dissolution rate (in-vitro).

In Vitro Antioxidant, Anti-inflammatory, Antimicrobial, and Antidiabetic Activities of Synthesized Chitosan-loaded p-Coumaric Acid Nanoparticles.

p-Coumaric acid is a phenolic compound widely distributed in fruits and vegetables that displays an array of therapeutic properties, including antidiabetic effects. Prominent application in diabetes is limited due to its suboptimal pharmacokinetics, poor aqueous solubility, and poor bioavailability. Nanotechnology-based delivery methods have been developed to address these limitations and improve the therapeutic uses of p-coumaric acid, and the nanoencapsulation method is emerging as a feasible alternative. The objective of this study is to synthesize p-coumaric acid nanoparticles (PCNPs) and to evaluate their In Vitro activities. The PCNPs were synthesized by the nanoprecipitation method and characterized by UV-visible spectroscopy, zeta potential, Fourier-transform infrared (FTIR) spectroscopy, and scanning electron microscopy (SEM) with dispersive energy X-ray (EDX) analysis. In addition, the PCNPs were analyzed for In Vitro antioxidant activity using six different free radical scavenging assays and were also analyzed for antimicrobial, anti-inflammatory, antithrombotic, and antidiabetic effects. The formation of PCNPs was confirmed by UV-visible spectra at 283 nm, and FTIR analysis revealed the reduction and capping of the chitosan nanoparticles. SEM was used to assess the size and shape of the PCNPs, and the high absorption property of the PCNPs was investigated using EDX analysis. The PCNPs had significant antioxidant, hydrogen peroxide (H2O2), lipid peroxidation (LPO), superoxide and nitric oxide (NO) radical scavenging power activities, and showed potent antimicrobial, anti-inflammatory, antithrombotic, and antidiabetic activities. The present study suggests that PCNPs can be used as a potential medication delivery approach to provide a greater nephroprotective effect in the treatment of diabetic nephropathy. To the best of our knowledge, this is the first attempt at the synthesis of chitosan-loaded PCNPs.

Novel pH-responsive E-selectin targeting natural polysaccharides hybrid micelles for diabetic nephropathy

Diabetic nephropathy (DN) is an important complication of diabetes and is the main cause of end-stage renal disease. The pathogenesis of DN is complex, including glucose and lipid metabolism disorder, inflammation, and so on. Novel hybrid micelles loaded Puerarin (Pue) based on Angelica sinensis polysaccharides (ASP) and Astragalus polysaccharide (APS) were fabricated with pH-responsive ASP-hydrazone-ibuprofen (BF) materials (ASP-HZ-BF, SHB) and sialic acid (SA) modified APS-hydrazone-ibuprofen materials (SA/APS-HZ-BF, SPHB) by thin-film dispersion method. The SA in hybrid micelles can specifically bind to the E-selectin receptor which is highly expressed in inflammatory vascular endothelial cells. The loaded Pue could be accurately delivered to the inflammatory site of the kidney in response to the low pH microenvironment. Overall, this study provides a promising strategy for developing hybrid micelles based on natural polysaccharides for the treatment of diabetic nephropathy by inhibiting renal inflammatory reactions, and antioxidant stress.

Lepidium sativum alleviates diabetic nephropathy in a rat model by attenuating glucose levels, oxidative stress, and inflammation with concomitant suppression of TGF-β1

In this research, the treatment of diabetic nephropathy in rats induced by streptozotocin with L. sativium whole-plant aqueous extract was examined, and the mechanism of action was proposed. Adult male rats were grouped into: control, L. sativum, T1DM, and T1DM + L. sativum-treated groups. For 8 weeks, L. sativum S was given to rats at a final dose of 250 mg/kg. Treatment with L. sativum reduced the amount of fasting glucose, increased the amount of fasting insulin, and diminished the increase in hepatic and serum cholesterol, free fatty acid, and triglyceride levels. The level of serum LDL-c was reduced. At the level of the kidney, L. sativum reduced urine volume and albumin excretion and spiked creatinine excretion. It also attenuated the tubular damage in the rats’ kidneys and reduced the amounts of major inflammatory markers, including nuclear factor-kappaα (NF-κB), tumor necrosis factor-α (TNF-α), and interleukin-6 (IL-6). Interestingly, L. sativium reduced the amount of mRNA transforming growth factor-β1 (TGF-β1), stimulated mRNA superoxide dismutase (SOD) and catalase (CAT), reduced lipid peroxide levels (MDA), and increased the glutathione (GSH), SOD, and CAT in the rat kidneys of the control and T1DM-treated group. In conclusion, L. sativum is a novel therapy against DN owing to its hypoglycemic effect, insulin-releasing, and antioxidant potential.

Isoliquiritigenin attenuates high glucose-induced proliferation, inflammation, and extracellular matrix deposition in glomerular mesangial cells by suppressing JAK2/STAT3 pathway.

To investigate the effect of isoliquiritigenin (ISL) on high glucose (HG)-induced glomerular mesangial cells (GMCs) proliferation, extracellular matrix (ECM) deposition and inflammation, and the underlying mechanisms. Mouse GMCs (SV40-MES-13) were cultured in HG medium, with or without ISL. The proliferation of GMCs was determined by MTT assay. The production of proinflammatory cytokines was detected by qRT-PCR and ELISA. The expression of connective tissue growth factor (CTGF), TGF-β1, collagen IV, and fibronectin was measured by qRT-PCR and western blot. The phosphorylation of JAK2 and STAT3 was examined by western blot. Next, JAK2 inhibitor AG490 was applied to HG-exposed GMCs. The levels of JAK2/STAT3 phosphorylation and pro-fibrotic markers were analyzed by western blot, and the secretion of TNF-α and IL-1β was evaluated by ELISA. GMCs were treated with HG, HG plus ISL or HG plus ISL, and recombinant IL-6 (rIL-6) which is a JAK2 activator. The levels of JAK2/STAT3 activation, ECM formation, and proinflammatory cytokines secretion were determined by western blot and ELISA, respectively. In mouse GMCs, ISL successfully repressed HG-induced hyperproliferation; production of TNF-α and IL-1β; expression of CTGF, TGF-β1, collagen IV, and fibronectin; and activation of JAK2/STAT3. Similar to ISL, AG490 was able to reverse the inflammation and ECM generation caused by HG. Moreover, rIL-6 impeded the amelioration of ISL on HG-induced adverse effects. Our study demonstrated that ISL displayed preventive effects on HG-exposed GMCs through inhibiting JAK2/STAT3 pathway and provided an insight into the application of ISL for diabetic nephropathy (DN) treatment.

The role of Chinese herbal medicine in the treatment of diabetic nephropathy by regulating endoplasmic reticulum stress.

Diabetic nephropathy (DN), a prevalent microvascular complication of diabetes mellitus, is the primary contributor to end-stage renal disease in developed countries. Existing clinical interventions for DN encompass lifestyle modifications, blood glucose regulation, blood pressure reduction, lipid management, and avoidance of nephrotoxic medications. Despite these measures, a significant number of patients progress to end-stage renal disease, underscoring the need for additional therapeutic strategies. The endoplasmic reticulum (ER) stress response, a cellular defense mechanism in eukaryotic cells, has been implicated in DN pathogenesis. Moderate ER stress can enhance cell survival, whereas severe or prolonged ER stress may trigger apoptosis. As such, the role of ER stress in DN presents a potential avenue for therapeutic modulation. Chinese herbal medicine, a staple in Chinese healthcare, has emerged as a promising intervention for DN. Existing research suggests that some herbal remedies may confer renoprotective benefits through the modulation of ER stress. This review explores the involvement of ER stress in the pathogenesis of DN and the advancements in Chinese herbal medicine for ER stress regulation, aiming to inspire new clinical strategies for the prevention and management of DN.

LncRNA SNHG1 knockdown inhibits hyperglycemia induced ferroptosis via miR-16-5p/ACSL4 axis to alleviate diabetic nephropathy.

Hyperglycemia accelerates the development of diabetic nephropathy (DN) by inducing renal tubular injury. Nevertheless, the mechanism has not been elaborated fully. Here, the pathogenesis of DN was investigated to seek novel treatment strategies. A model of diabetic nephropathy was established in vivo, the levels of blood glucose, urine albumin creatinine ratio (ACR), creatinine, blood urea nitrogen (BUN), malondialdehyde (MDA), glutathione (GSH), and iron were measured. The expression levels were detected by qRT-PCR and Western blotting. H&E, Masson, and PAS staining were used to assess kidney tissue injury. The mitochondria morphology was observed by transmission electron microscopy (TEM). The molecular interaction was analyzed using a dual luciferase reporter assay. SNHG1 and ACSL4 were increased in kidney tissues of DN mice, but miR-16-5p was decreased. Ferrostatin-1 treatment or SNHG1 knockdown inhibited ferroptosis in high glucose (HG)-treated HK-2 cells and in db/db mice. Subsequently, miR-16-5p was confirmed to be a target for SNHG1, and directly targeted to ACSL4. Overexpression of ACSL4 greatly reversed the protective roles of SNHG1 knockdown in HG-induced ferroptosis of HK-2 cells. SNHG1 knockdown inhibited ferroptosis via the miR-16-5p/ACSL4 axis to alleviate diabetic nephropathy, which provided some new insights for the novel treatment of diabetic nephropathy.

Ferroptosis: a new strategy for Chinese herbal medicine treatment of diabetic nephropathy.

Diabetic nephropathy (DN) is a serious microvascular complication of diabetes. It has become a leading cause of death in patients with diabetes and end-stage renal disease. Ferroptosis is a newly discovered pattern of programmed cell death. Its main manifestation is the excessive accumulation of intracellular iron ion-dependent lipid peroxides. Recent studies have shown that ferroptosis is an important driving factor in the onset and development of DN. Ferroptosis is closely associated with renal intrinsic cell (including renal tubular epithelial cells, podocytes, and mesangial cells) damage in diabetes. Chinese herbal medicine is widely used in the treatment of DN, with a long history and definite curative effect. Accumulating evidence suggests that Chinese herbal medicine can modulate ferroptosis in renal intrinsic cells and show great potential for improving DN. In this review, we outline the key regulators and pathways of ferroptosis in DN and summarize the herbs, mainly monomers and extracts, that target the inhibition of ferroptosis.

Haptoglobin and lipid profile in diabetic nephropathy in Ilorin, Kwara state

Background: Diabetic Nephropathy (DN) is a common cause of abnormal lipoprotein metabolism and can be influenced by impairment of renal function and metabolic controls in diabetes. Aim: The aim of this study is to determine the level of Haptoglobin and Lipid Profile in Diabetic Nephropathy Patients. Subjects and Method: A prospective case-controlled study was carried out among Diabetic Nephropathy Patients and Control with a total number of 50 DN Patients and 50 Non-Diabetics control subjects respectively. Serum Glucose estimation was analyzed using Glucose Oxidase Peroxidase (GOD) method, Serum Haptoglobin was determined using a Nephelometric method while the Lipid Profile (Total cholesterol, Triglycerides, and HDL-cholesterol) was assayed using an enzymatic method of estimation, while LDL-cholesterol was calculated by Friedewald equation. Body Mass Index (BMI, kgm-2) was calculated from height and weight which were obtained from a questionnaire used to record the demographic features of all the participants/subjects. Result: The results obtained show that serum glucose was significantly increased in Diabetic Nephropathy Patients (8.62 ± 1.34, p<0.05) when compared with control subjects (3.02 ± 0.88, p<0.05). There was also a significant increase (p<0.05) in mean Serum Haptoglobin (38.25 ± 6.67) in Diabetics when compared with control subjects (19.40 ± 3.92). A significant increase was also observed in Triglycerides in DN Patients with a mean of (0.77 ± 0.53, p<0.05) when compared to control subjects (0.63 ± 0.26). However, there were no significant increases in Total Cholesterol and LDL-Cholesterol, with their mean value of (4.15 ± 1.27 and 1.95 ± 0.72) when compared to control subjects (3.59 ± 1.04 and 3.59 ± 1.04) respectively. While an insignificant decrease was observed in DN Patient’s HDL-cholesterol mean value (0.81 ± 0.34) when compared to control subjects (1.18 ± 0.19). In this study, a strong statistically significant positive correlation was observed in Haptoglobin and Total cholesterol (R= 0.939, P= 0.015), HDL-C (R= 0.897, P= 0.025). Conclusion: This study showed increased levels of Fasting Blood Glucose, Serum Haptoglobin, and Triglycerides increased Diabetic Nephropathy in Ilorin. Lipid control appears to be important in the prevention and treatment of Diabetic Nephropathy. This study suggests that serum Hp levels may be used as a potential biomarker for the early diagnosis of Diabetic Kidney Diseases in Diabetes Patients.

Coptisine mitigates diabetic nephropathy via repressing the NRLP3 inflammasome.

Diabetic nephropathy is a microvascular complication of diabetes mellitus, threatening the health of millions of people. Herein, we explored a blood glucose independent function of coptisine on diabetic nephropathy. A diabetic rat model was established by intraperitoneal administration of streptozotocin (65 mg/kg). Coptisine treatment (50 mg/kg/day) retarded body weight loss and reduced blood glucose. On the other hand, coptisine treatment also decreased kidney weight and the levels of urinary albumin, serum creatinine, and blood urea nitrogen, indicating an improvement of renal function. Treatment with coptisine also mitigated renal fibrosis, with alleviative collagen deposition. Likewise, in vitro study showed that coptisine treatment decreased apoptosis and fibrosis markers in HK-2 cells treated with high glucose. Furthermore, after coptisine treatment, the activation of NOD-like receptor pyrin domain containing protein 3 (NRLP3) inflammasome was repressed, with decreased levels of NLRP3, cleaved caspase-1, interleukin (IL)-1β, and IL-18, indicating that the repression of NRLP3 inflammasome contributed to the effect of coptisine on diabetic nephropathy. In conclusion, this study revealed that coptisine mitigates diabetic nephropathy via repressing the NRLP3 inflammasome. It is indicated that coptisine may have the potential to be used in the diabetic nephropathy treatment.

Protocolo diagnóstico de la nefropatía diabética

Diabetes mellitus has become an important health problem. Diabetic nephropathy (DN) is the leading cause of advanced chronic kidney disease and for starting renal replacement therapy. DN can occur in both type 1 and type 2 diabetes mellitus. Early follow-up on patients through the periodic determination of microalbuminuria and the estimated glomerular filtration rate will help in the early detection of DN in the initial clinical phase in which it is still potentially reversible, preventing progression to renal failure. In this sense and given the multiple microvascular and macrovascular complications arising from diabetes, both the diagnosis and early multidisciplinary treatment of diabetic nephropathy are necessary.

Radix puerariae in the treatment of diabetic nephropathy: A network pharmacology analysis and experimental validation

Abstract Radix puerariae has become the most commonly used medicine for diabetic nephropathy (DN). However, the mechanism of Radix puerariae in the treatment of DN is not completely clear. This study is to determine the active ingredients, targets, and signaling pathways of Radix puerariae for the treatment of DN using network pharmacology analysis and animal experiments to confirm its possible mechanism of action. A total of 12 potential effective components and 10 key therapeutic targets were obtained. The Kyoto Encyclopedia of Genes and Genomes enrichment analysis indicated that the use of Radix puerariae in DN treatment mainly involves HIF-1 signaling pathway, TNF signaling pathway, mTOR signaling pathway, PI3K-Akt signaling pathway, FoxO signaling, and VEGF signaling pathway. Molecular docking proved that the combined activity of the components with potential key targets were excellent. Animal experiments showed that Radix puerariae could improve the renal pathological structure in DN rats. Radix puerariae could decrease the content of AKT1, IL-6, INS, and reduce the expression levels of p-Akt/Akt and p-FoxO1/FoxO1 in renal tissue of DN rats. This study provides insight into the therapeutic potential and molecular mechanisms of Radix puerariae for treating DN.

Diosgenin alleviates the inflammatory damage and insulin resistance in high glucose‑induced podocyte cells via the AMPK/SIRT1/NF‑κB signaling pathway.

Diabetic nephropathy (DN) is the predominant cause of end-stage renal disease globally. Diosgenin (DSG) has been reported to play a protective role in podocyte injury in DN. The present study aimed to explore the role of DSG in DN, as well as its mechanism of action in a high glucose (HG)-induced in vitro model of DN in podocytes. Cell viability, apoptosis, inflammatory response and insulin-stimulated glucose uptake were evaluated using Cell Counting Kit-8, TUNEL, ELISA and 2-deoxy-D-glucose assay, respectively. In addition, the expression of AMP-activated protein kinase (AMPK)/sirtuin 1 (SIRT1)/NF-κB signaling-related proteins in podocyte cells was measured using western blotting. The results indicated that DSG enhanced the viability of podocytes after HG exposure, but inhibited inflammatory damage and attenuated insulin resistance. Moreover, DSG induced the activation of the AMPK/SIRT1/NF-κB signaling pathway. Furthermore, treatment with compound C, an inhibitor of AMPK, counteracted the protective effects of DSG on HG-induced podocyte cells. Therefore, DSG may be a potential therapeutic compound for the treatment of diabetic nephropathy.

Combination of Astragalus membranaceus and Panax notoginseng as Main Components in the Treatment of Diabetic Nephropathy: A Systematic Review and Meta-Analysis

This meta-analysis evaluated the curative effect of the compatibility of Astragalus membranaceus and Panax notoginseng (ARPN) as main components on diabetic nephropathy. We used various Chinese and English databases, including the Cochrane Library, PubMed, Embase, Web of Science, the China National Knowledge Infrastructure (CNKI), China Biology Medicine Disc (SinoMed), VIP, and Wanfang, to search for randomized controlled trials on the compatibility of Astragalus membranaceus and Panax notoginseng as main components. After data extraction, meta-analysis was performed with Review Manager 5.4.0 and Stata 15, and the Grading of Recommendations Assessment, Development, and Evaluation (GRADE) framework was used to evaluate the quality of the evidence. A total of 17 studies involving 1342 patients with diabetic nephropathy were included. Compared with the control group, ARPN can significantly improve the clinical effective rate of diabetic nephropathy (OR 5.12, 95% CI 3.42 to 7.66, P < 0.00001), and the curative effect of reducing UAER (MD -26.67, 95% CI -31.30 to -22.04, P < 0.00001) and 24 h urinary protein (SMD -0.58, 95% CI -0.75 to -0.41, P < 0.00001) is also significantly better than that of the control group, and it can also improve the renal function(Scr: MD -13.78, 95% CI -25.39 to -2.17, P=0.02; BUN: MD -0.74, 95% CI -1.27 to -0.20, P=0.007). In addition, it can also reduce glycosylated hemoglobin (SMD -1.30, 95% CI -2.33 to -0.27, P=0.01) and blood lipid(TC: SMD -0.62, 95% CI -0.95 to -0.29, P=0.0002; TG: SMD -0.47, 95% CI -0.75 to -0.19, P=0.0009; LDL: SMD -0.43, 95% CI -0.68 to -0.18, P=0.0008), and improve the TCM syndrome score (MD -4.87, 95% CI -6.17 to -3.57, P < 0.00001). Subgroup analysis suggested that the treatment plan of the control group could be the sources of heterogeneity. All the included studies had no obvious adverse effects. The compatibility of Radix Astragali and Radix notoginseng as the main components can effectively improve the renal function of patients with diabetic nephropathy and delay the progress of diabetic nephropathy. However, the results of this study need further research to be confirmed because of the uncertainty of the evidence and the suboptimal risk bias.

Role of circulating C-peptide in the Indian population with Type 2 diabetics with nephropathy: A triangular relationship between C-peptide, HbA1C and microalbuminuria

C-peptide levels can initially be normal or increased in type 2 diabetes mellitus (T2DM), which is connected to insulin resistance; however, as the condition progresses, these levels may fall. According to studies, kidney failure has diabetes as its primary cause, accounting for 44% of all new cases. In addition, it's critical to strictly regulate blood sugar levels and lower protein intake. Along with insulin, the pancreas produces a molecule called C-peptide. The hormone insulin regulates the body's glucose levels. A total of 300 subjects divided into 150 CKD progression diabetic nephropathy and 150 non-progressions diabetic nephropathy based on clinical parameter assessment. All patients had their body weight and body mass index (BMI) assessed. Fasting serum C peptide, HbA1C, serum creatinine, blood urea nitrogen, urine albumin, and creatinine were among the laboratory tests performed. Using the MDRD algorithm, creatinine clearance was determined from serum creatinine value. The parameters were statistically compared with respective subjects. The small case-control study found a no relationship between serum C-peptide levels and both microalbuminuria and HbA1C. Risk of microalbuminuria may be higher in patients with low serum C peptide levels. In patients with T2DM, replacing C-peptide and administering insulin may be useful. The possibility that C-peptide may play a part in the prevention and treatment of diabetic nephropathy will need to be investigated in studies including longer-term C-peptide administration.

Clinical study on prescription used for invigorating spleen, reinforcing kidney and warming yang combined with calcium dobesilate in treatment of senile diabetic nephropathy

ABSTRACT Objective. To analyze the clinical effect of prescription used for invigorating spleen, reinforcing kidney and warming yang combined with calcium dobesilate to treat senile diabetic nephropathy (DN). Methods. The clinical data of 110 elderly patients with DN in our hospital from November 2020 to November 2021 were selected for retrospective analysis, and they were divided into the observation group (OG, n = 55) and the control group (CG, n = 55) according to the principle of random grouping. The CG received conventional therapy and calcium dobesilate, and the OG received conventional therapy, calcium dobesilate and prescription used for invigorating spleen, reinforcing kidney and warming yang to evaluate the clinical value of different treatment programs by comparing their clinical indicators after treatment. Results. The total effective rate of clinical treatment in the OG was clearly higher than the CG (P < 0.05). The blood glucose indexes, and the levels of ALB and RBP in the OG were visibly lower than the CG after treatment (P < 0.001). After treatment, the average levels of BUN and Cr in the OG were visibly lower than the CG (P < 0.001), while the average eGFR level was significantly higher than the CG (P < 0.001). Conclusion. The prescription used for invigorating spleen, reinforcing kidney and warming yang combined with calcium dobesilate is a reliable method to improve the hemorheology indexes and renal function of DN patients, which benefits patients, and further studies are helpful to establish a better solution for such patients.

New stability indicating liquid chromatographic method for the estimation of Valsartan in pharmaceutical dosage forms

Valsartan is an orally active antihypertensive agent which belongs to the category of angiotensin II type I receptor antagonists. Valsartan is used for the treatment of heart failure, hypertension, myocardial infraction and diabetic nephropathy. A new stability indicating RP-HPLC was proposed for the quantification of Valsartan by using an ion-pairing agent, tetra butyl ammonium hydrogen sulphate. Mobile phase mixture consisting of 10 mM tetra butyl ammonium hydrogen sulphate and methanol (25: 75, v/v) was selected with a flow rate of 1 ml/min using Agilent C18 column (Detection wavelength 250 nm). The LOD and LOQ were found to be 0.0291 μg/mL and 0.0897 μg/mL respectively. Linearity was observed over the concentration 0.1-50 μg/mL with linear regression equation, y = 36571x + 13532 and the method is precise, accurate and robust. Stress degradation studies were performed and the method was found to be selective and specific.

Evaluation of Sida cordifolia and Sida rhombifolia extracts in a rat model of streptozotocin-induced diabetic nephropathy.

Sida cordifolia and Sida rhombifolia are regarded as useful herbs as they have been shown to be effective, inexpensive and harmless in the prevention of diabetes, and are recognized as valuable therapeutic substances. The purpose of this study was to assess the effect of S. cordifolia and S. rhombifolia in the treatment of diabetic nephropathy using a rat model. Extracts of S. cordifolia and S. rhombifolia were obtained using the Soxhlet method. The hydroalcoholic extract solvent was used in the following proportions: 70:30, 50:50 and 80:20. The 80:20 hydroalcoholic extract was observed to be the most potent. The inhibitory effects of the extract were determined using the α-amylase assay. The most potent extract also underwent total flavonoid, phenolic and free radical scavenging tests, and was incorporated into an animal study. Diabetes was induced in rats by administering nicotinamide (NAD; 230 mg/kg) and streptozotocin (STZ; 65 mg/kg) intraperitoneally. In addition to a standard control of pioglitazone, the rats received extract dosages of 100 mg/kg/day or 200 mg/kg/day. Body weight, blood glucose, glycated hemoglobin (HbA1c), blood urea nitrogen (BUN), serum albumin, serum creatinine, homeostatic model assessment of insulin resistance (HOMA-IR), and oral glucose tolerance were assessed at various time points. The animals also underwent histopathological examination to observe alterations induced by the treatment. Sida cordifolia was the most successful in lowering blood glucose and HbA1c levels. Renal function indices and antioxidant enzyme levels were regained in a dose-dependent manner. Furthermore, S. cordifolia (200 mg/kg/day) extract, similar to pioglitazone, inhibited the production of advanced glycation byproducts by the kidney. The effects of various S. cordifolia and S. rhombifolia extracts on rats with diabetic nephropathy were observed. Sida cordifolia may be further explored for the treatment of diabetic nephropathy and, due to its diverse nature, may be utilized for the treatment of a wide range of diseases, as it provided more significant findings.

Can DPP-4 Enhibitors and SGLT-2 Inhibitors Pleotropic Effects be Extended to Treat Diabetic Nephropathy?

Impaired insulin secretion and resistance remain the core defects in T2DM, but at least six other pathophysiological abnormalities contribute to the dysregulation of glucose metabolism. Diabetic nephropathy is one of the most common microvascular complications and a major cause of end-stage renal disease. Despite many treatment options available, diabetic kidney disease continues to affect a large population with diabetes. The kidneys have the highest DPP-4 expression level in mammalians. DPP- 4 is expressed in several segments of the nephron and the tubule interstitium, placing it at the nexus of inflammation, immune system activation, glomerular and proximal tubular function, salt regulation, and kidney fibrosis. Moreover, DPP-4 expression and urinary activity are up-regulated in diabetic nephropathy, highlighting its role as a potential target to manage diabetic nephropathy. DPP-4 inhibition is associated with mitigation of diabetic and hypertensive renal injury and protection of renal function. Renal glucose reabsorption by SGLT proteins is a critical component of glycemic regulation. SGLT2 protein expression is increased in human diabetic nephropathy even with advanced kidney disease indicating that SGLT2 can be an effective target in treatment of diabetic nephropathy. This review article discusses roles played by DPP-4 inhibitors and SGLT-2 inhibitors alone and in combination in diabetic nephropathy supported by clinical evidences. MEDLINE and EMBASE were searched through September 2022. Randomized controlled trials published in English that evaluated SGLT2 inhibitors and/or DPP4 inhibitors in patients with T2DM were selected. J MEDICINE 2023; 24: 43-49