Traditional Chinese Medicine for Refractory Nephrotic Syndrome: Strategies and Promising Treatments

Abstract

Refractory nephrotic syndrome (RNS) is an immune-related kidney disease with poor clinical outcomes. Standard treatments include corticosteroids as the initial therapy and other immunosuppressants as second-line options. A substantial proportion of patients with RNS are resistant to or dependent on immunosuppressive drugs and often experience unremitting edema and proteinuria, cycles of remission and relapse, and/or serious adverse events due to long-term immunosuppression. Traditional Chinese medicine has a long history of treating complicated kidney diseases and holds great potential for providing effective treatments for RNS. This review describes the Chinese medical theories relating to the pathogenesis of RNS and discusses the strategies and treatment options using Chinese herbal medicine. Available preclinical and clinical evidence strongly supports the integration of traditional Chinese medicine and Western medicine for improving the outcome of RNS. Herbal medicine such as Astragalus membranaceus, Stephania tetrandra S. Moore, and Tripterygium wilfordii Hook F can serve as the alternative therapy when patients fail to respond to immunosuppression or as the complementary therapy to improve therapeutic efficacy and reduce side effects of immunosuppressive agents. Wuzhi capsules (Schisandra sphenanthera extract) with tacrolimus and tetrandrine with corticosteroids are two herb-drug combinations that have shown great promise and warrant further studies.

Chinese Herbal Injections for Primary Nephrotic Syndrome in Adults: A Systematic Review and Network Meta‐Analysis

“…is indicates the importance of blood stasis syndrome and Qi deficiency syndrome in PNS, which is consistent with previous studies [18]. According to TCM theory, Qi deficiency is involved in the pathogenesis of nephrotic syndrome, and blood stasis acts as a key pathological factor to further complicate the condition [8]. A TCM syndrome study in PNS showed that Qi deficiency is one of the most common TCM syndrome types, whose score correlated significantly with higher urine protein/creatinine ratio and TC level [19].…”

“…Moreover, recommended treatments for PNS can also cause unwanted side effects [5][6][7]. Traditional Chinese medicine (TCM) has been documented to have a beneficial effect for PNS diagnosed based on individual symptoms, but not the pathological type; thus, TCM might be a potential adjuvant or alternative treatment for PNS [8][9][10]. Chinese herbal injections (CHIs) are innovative formulations of herbs with high bioavailability and rapid action that are widely administered in China [11].…”

Astragalus membranaceus (Fisch.) Bunge repairs intestinal mucosal injury induced by LPS in mice

“…[ 3 ]. This herb possesses many common pharmacological activities, such as multiple organ protection [ 4 , 5 ], antioxidant [ 6 ], hypoglycemic [ 7 ], antiviral [ 8 ] and so on, and has their own pharmacological properties and mechanisms. Studies have shown that A. membranaceus can enhance the contraction of the right ventricular myocardium in rats in a dose-dependent manner [ 9 ] and has recently been reported to be a potential promote tissue wound repair.…”

Exploring protective effect of Glycine tabacina aqueous extract against nephrotic syndrome by network pharmacology and experimental verification

“…According to its histological characteristics, NS can be classified into several types including minimal change disease, membranous proliferative glomerulo-nephritis, focal segmental glomerulosclerosis, and membranous nephropathy [4]. The annual incidence of NS has been estimated to be 3 per 100,000 adults and 2-7 per 100,000 children, posing an enormous burden on both society and individuals due to the high risk for the progression of end stage renal disease [5,6]. The main therapeutic agents for NS are glucocorticoids, immunosuppressants and cytotoxic drugs.…”

“…The limited success of clinically available therapies for NS highlights the pressing requirement for the development of more effective and safer alternative agents. Thanks to the low side effects, rich resource and remarkable efficacy of traditional Chinese medicine (TCM), TCM, as one of the major modalities in complementary and alternative medicine, has a long history for treating a variety of nephropathies [6,8,9]. Network pharmacology is a systematic approach, which is used to understand the complexities among compounds, targets, diseases and biosystems [10].…”