Emodin-Mediated Treatment of Acute Kidney Injury

Abstract

Acute kidney injury (AKI), a common condition associated with a high mortality rate, is characterized by declined glomerular filtration rate, retention of nitrogen products, and disturbances in balance of water, electrolyte, and acid-base. Up to date, there is no effective treatment for AKI. Despite the continuous improvement in blood purification techniques, a considerable proportion of patients with AKI still progress to end-stage renal disease. These patients with advanced stage of end-stage renal disease will require long-term renal replacement therapy, which places a heavy burden on the family and the society. In recent years, the use of traditional Chinese medicine (TCM) in AKI management has been gradually increasing. Clinical evidence has demonstrated that three-month treatment with TCM produced better clinical outcomes in terms of clinical effectiveness rate and improvement in renal function (serum creatinine, neutrophil gelatinase-associated lipocalin, and cystatin C) compared with Western medicine. Rhubarb is a commonly used herb in TCM for the treatment of AKI. The main active component of rhubarb is emodin, which was first recorded in Shennong’s Classic of Materia Medica. It has been shown that emodin has a variety of pharmacological activities including antibacterial, anti-inflammatory, antiulcer, and immunosuppressive effects. Emodin has been found to be effective against renal fibrosis and has been widely studied for its effects on kidney diseases such as diabetic nephropathy, renal fibrosis, and AKI. Moreover, promising results have been obtained from these studies. In this study, the results obtained from research on the use of emodin for AKI treatment has been reviewed.

Exploring anti-acute kidney injury mechanism of Dahuang-Gancao decoction by network pharmacology and experimental validation

“…This may be attributed to Emodin, an active ingredient of Rhubarb that increases glomerular filtration by inhibiting glomerular podocyte apoptosis and endoplasmic reticulum stress [ 24 ]. DHGC’s main component, Rhein, possesses various pharmacological activities, such as antibacterial, anti-inflammatory, and anti-ulcer effects, and delays the progression of AKI [ 2 ]. Nevertheless, Rhubarb may increase kidney damage due to its toxicity, which should not be ignored [ 25 ].…”

“…Acute kidney injury (AKI) is a clinical condition characterized by a rapid decline in renal excretory function, accumulation of nitrogen metabolites, reduced urine output, metabolic acidosis, and elevated potassium and phosphorus concentrations [ 1 , 2 ]. Recent statistics indicate a high incidence of AKI globally, with more than 5,000 cases per million people per year of non-dialysis AKI and 295 cases per million people per year requiring dialysis, and a high overall mortality rate [ 3 ].…”

“…Modern pharmacological studies have shown that Rhubarb and licorice play an important role in the treatment of AKI [ 7 , 8 ]. For example, Rhubarb and its active components possess anti-inflammatory, antioxidant, and antiapoptotic effects, which can effectively delay the progression of AKI [ 2 , 9 ]. Licorice can alleviate methotrexate-induced AKI by decreasing oxidative stress and suppressing the ensuing activation of proapoptotic and proinflammatory pathways [ 10 ].…”

Network pharmacology and molecular docking technology-based predictive study of the active ingredients and potential targets of rhubarb for the treatment of diabetic nephropathy

“…However, it has not been reported that regular consumption of Rhubarb caused secondary hyperoxaluria and renal failure. In addition, Liu et al reported that the main active component of rhubarb, emodin, may provide clinical benefits in the treatment of AKI [ 94 ]. Therefore, more clinical evidence needs to be collected to further investigate the relationship between Rhubarb and AKI.…”