Abstract
Extracorporeal shock wave lithotripsy (ESWL)-induced renal damage can occur as a result of multiple mechanisms. We have reported previously that Astragalus membranaceus, Salvia miltiorrhiza, a decoction of six drugs containing rhizoma Rehmanniae preparata and supplements of a few traditional Chinese medicinal herbs for invigorating the kidney and excreting calculus, have a protective effect on renal injury induced by high-energy shock waves (HESW) in rabbits. In this clinical study we further investigate the protective effects of these traditional Chinese herbs against renal damage induced by ESWL. Sixty consenting patients with renal calculus who underwent ESWL treatment were included and randomly assigned to the medication group or control group. Post-ESWL plasma nitric oxide (NO), endothelin-1 (ET-1), malondialdehyde (MDA), and serum tumor necrosis factor α (TNF-α) increased significantly in the controls (P < 0.05), while in the medication group, slightly but not significantly elevated levels of plasma ET-1, NO, and serum TNF-α were found. The difference between the groups was statistically significant (P < 0.05). The levels of superoxide dismutase (SOD) decreased gradually in the controls, reaching a trough 72 h after ESWL (P < 0.05), while in the treated group it was unchanged, and remained at a level higher versus the controls (P < 0.05). Plasma NO peaked twice by 72 h and at 1 week in the controls (P < 0.05). Urinary enzymes and β2-microglobulin increased significantly and peaked by 24 h and immediately after ESWL (P < 0.05). These values were greater in the controls, and the difference was statistically significant (P < 0.05). This study demonstrates that the preparations of traditional Chinese medicines for invigorating the kidney and excreting calculus can reduce renal tubular damage induced by ESWL, and can shorten the recovery time of renal tubules in human subjects.
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References
Evan AP, Willis LR, Mcateer JA, Bailey MR, Connors BA, Shao Y, Lingeman JE, Willliaas JC Jr, Fineberg NS, Crum LA (2002) Kidney damage and renal functional changes are minized by waveform control that suppresses cavitation in shock wave lithotripsy. J Urol 168:1556–1562
Li X, He D, Zhang L, Cheng X, Sheng B, Luo Y (2006) A novel antioxidant agent, astragalosides, prevents shock wave-induced renal oxidative injury in rabbits. Urol Res 34:277–282
Ogiste JS, Nejat RJ, Rashid HH, Greene T, Gupta M (2003) The role of mannitol in alleviating renal injury during extracorporeal shock wave lithotripsy. J Urol 169:875–877
Munver R, Delvecchio FC, Kuo RL, Brown SA, Zhong P, Preminger GM (2002) In vivo assessment of free radical activity during shock wave lithotripsy using a microdialysis system: the renoprotective action of allopurinol. J Urol 167:327–334
Yaman O, Sarica K, Ozer G, Soygur T, Kutsal O, Yaman LS, Gous O (1996) Protective effect of verapamil on renal tissue during shock wave application in rabbit model. J Endourol 10:329–333
Sheng BW, Chen XF, Zhao J, He DL, Nan XY (2005) Astragalus membranaceus reduces free radical-mediated injury to renal tubules in rabbits receiving high-energy shock waves. Chin Med J (Engl) 118:43–49
Chen XF, Sheng BW, He DL, Nan XY (2004) Protective effects of salvia miltiorrhiza and verapamil on high energy shock wave induced renal damage in rabbits. Disi Junyi Daxue Xuebao 25:363–364
Chen XF, Gao ZW, Sheng BW, He DL, Wang MZ, Nan XY (2002) Protective effect of herbal medicine on renal damage induced by high energy shock wave. Zhongguo Zhong Xi Yi Jie He Waike Zazhi 8:428–430
Zhang JW (2006) History progress of pharmacology of tranditional Chinese medical formulae about Liuwei Dihuang Pill and its clinical application in ancient times. Shijie Kexue Jishu-Zhong Yi Yao Xian Dai Hua 8:123–130
Zhou J, Xu X, Liu JJ, Lin YX, Gao GD (2007) Angiotensin II receptors subtypes mediate diverse gene expression profile in adult hypertrophic cardiomyocytes. Clin Exp Pharmacol Physiol 34:1191–1198
Karlin GS, Schulsinger D, Urivetsky M, Smith AD (1990) Absence of persisting parenchymal damage after extracorporeal shock wave lithotripsy as judged by excretion of renal tubular enzymes. J Urol 144:13–14
Sheng BW, Chen XF, Li X, He DL (2006) The change of urinary β2-MG, NAG and γ-GT levels in the patients with renal calculus and its clinical value. Xiandai Mi Niao Waike Zazhi 6:13–15
Delvecchio F, Auge BK, Munver R, Brown SA, Brizuela R, Zhong P, Preminger GM (2003) Shock wave lithotripsy causes ipsilateral renal injury remote from the focal point: the role of regional vasoconstriction. J Urol 169:1526–1529
Boaz M, Matas Z, Biro A, Katzir Z, Green M, Fainaru M, Smetana S (1999) Serum malondialdehyde and prevalent cardiovascular disease in hemodialysis. Kidney Int 56:1078–1083
Vaziri ND, Lin CY, Farmand F, Sindhu RK (2003) Superoxide dismutase, catalase, glutathione peroxidase and NADPH oxidase in lead-induced hypertension. Kidney Int 63:186–194
Vaziri ND, Dicus M, Ho ND, Boroujerdi-Rad L, Sindhu RK (2003) Oxidative stress and dysregulation of superoxide dismutase and NADPH oxidase in renal insufficiency. Kidney Int 63:179–185
Tang W, Zhu ML, Song MH (2002) Effect of Chinese yam polysaccharides on SOD of mice. Huanggang Zhiye Jishu Xueyuan Xuebao 4:42
Tian XQ, Liu PF (2005) A progress of study on Chinese medicine treatment of nephrotic syndrome in the animal experiment. Zhongguo Zhong Xi Yi Jie He Shen Bing Zazhi 6:243–245
Tian LQ, Ma L, Dou NS (2002) A review on pharmacological action of oleanolic acid. Zhongguo Zhong Yao Zazhi 27:884–886,901
Bian HM, Zhang X, Gong JN, Zhu P, Wei KF, Liu XF (2002) Influence of pharmacological serum of Liuwei Dihuang Decoction against apoptosis of vascular endothelial cells (VEC). Zhong Yao Yao Li Yu Lin Chuang 18:9–11
Liu D, Liu S, Huang Y, Liu Y, Zhang Z, Han L (2000) Effect of selenium on human myocardial glutathione peroxidase gene expression. Chin Med J (Engl) 113:771–775
Chen P, Zhou JF (2001) Abnormal metabolism of nitric oxide, oxidative stress and lipoperoxidative stress in patients with acute viral myocarditis. Chin Med J (Engl) 114:1132–1135
Strohmaier WL, Lahme S, Weidenbach PM, Bichler KH (1999) Reduction of high-energy shock-wave-induced renal tubular injury by selenium. Urol Res 27:382–385
Shiraishi N, Kitamura K, Kohda Y, Narikiyo T, Adachi M, Miyoshi T, Iwashita K, Nonoguchi H, Miller RT, Tomita K (2002) Increased endothelin-1 expression in the kidney in hypercalcemic rats. Kidney Int 63:845–852
Sondén A, Svensson B, Roman N, Brismar B, Palmblad J, Kjellström BT (2002) Mechanisms of shock wave induced endothelial cell injury. Lasers Surg Med 31:233–241
Mahmood N, Turner W, Rowgaski K, Almond D (1998) The patient’s perspective of extracorporeal shock wave lithotripsy. Int Urol Nephrol 30:671–675
Sheng BW, He DL, Chen XF, Nan XY (2004) Experiment study of the protective effects of Astragalus membranaceus (huangqi) on renal damage induced by ESWL. Zhong Hua Mi Niao Waike Zazhi. 25:163–166
He L, Cai Y, Chen ZH, Hu HY, Wang NS (2007) Effect of Wuling Powder on expression of endothelin receptor A of renal tissue in rats with adriamycin-induced nephrosis. Zhong Cheng Yao 29:963–966
Yang JH, Zhang YY, Wang HF (2008) Influence of Yin-nourishing Qi- tonifying and blood-activating recipe on an ticoagulation and fabrinolys is of cultured human umbilicalve in endothelial cells. Chin J TCM WM Crit Care 15:3–5
Bian HM, Gong JN, Wei KF, Liu XF, Yu JH (2005) Protective effect of Liuwei Dihuang Decoction on thrombosis in aged rats with blood stasis. Zhong Yao Yao Li Yu Lin Chuang 21(4):2–4
Frigo DE, Vigh KA, Struckhoff AP, Elliott S, Beckman BS, Burow ME, McLachlan JA (2005) Xenobiotic-induced TNF-alpha expression and apoptosis through the p38 MAPK signaling pathway. Toxicol Lett 155:227–238
Xun XY, Li LH, Wu LS, Zhao CL, Lin HY (2002) Adjustment effect of Radix Astragalus and Radix Angelicae sinensis on TNF-alpha and bFGF on renal injury induced by ischemia reperfusion in rabbit. Zhongguo Zhong Yao Za Zhi 27:771–773
Li HL, Chen YH, Zeng RX (2005) A research progress on regulation of Chinese medicine on cytokine in patients with kidney disease. Shiyong Zhong Xi Yi Jie He Lin Chuang 5:79–81
Ballermann BJ, Dardik A, Eng E, Liu A (1998) Shear stress and the endothelium. Kidney Int Suppl 67:S100–S108
Wu ZL, Qiu LQ (2001) Effect of nitric oxide on iron-mediated cytotoxicity in primary cultured renal proximal tubules. Cell Biochem Funct 19:237–247
Park JK, Cui Y, Kim MK, Kim YG, Kim SH, Kim SZ, Cho KW (2002) Effects of extracorporeal shock wave lithotripsy on plasma levels of nitric oxide and cyclic nucleotides in human subjects. J Urol 168:38–42
Aksoy Y, Aksoy Y, Turhan H, Keles S, Ziypak T, Ozbey I (2007) The effect of shock wave lithotripsy on nitric oxide and malondialdehyde levels in plasma and urine samples. Cell Biochem Funct 25:533–536
Park JK, Cui Y, Kim HJ, Oh HK, Koh GY, Cho KW (2003) Activation of nitric oxide-cyclic guanosine monophosphate signaling in kidney by extracorporeal shock wave therapy. J Urol 170:2459–2462
Aksoy Y, Malkoc I, Atmaca AF, Aksoy H, Altinkaynak K, Akcay F (2006) The effects of extracorporeal shock wave lithotripsy on antioxidant enzymes in erythrocytes. Cell Biochem Funct 24:467–469
Gurel A, Armutcu F, Sahin S, Sogut S, Ozyurt H, Gulec M, Kutlu NO, Akyol O (2004) Protective role of alpha-tocopherol and caffeic acid phenethyl ester on ischemia-reperfusion injury via nitric oxide and myeloperoxidase in rat kidneys. Clin Chim Acta 339:33–41
Liu WG, Jiang SH (2006) Effects of Huangqi-jianzhong decoction on the expression of epidermal growth factor, mRNA of inducible Nitric-oxide synthase and epidermal growth factor receptor in stomach mucosa of chronic atrophic gastritis rats with syndrome of spleen deficiency. Zhongguo Lin Chuang Kang Fu Zazhi 43:123–125
Chen TG, Xie XD, Chen HJ, Yu M, Chen JZ (2007) Effects of Astragalus on number, activity and iNOS of endothelia-l progenitor cells. Zhong Yao Yao Li Yu Lin Chuang 23:47–50
Yao XH (2007) Medicinal Efficacy of Plantain and Measuring Method of Valid Composition. Anhui Nongye Kexue 35:1053–1054,1062
Cao ZG, Su H, Zhu YP, Sun YW, Dong XC, Wu B (2008) Evaluation of efficacy of use of liquid apozema extracts of Alisma Orientatis for medical expulsive treatment of upper urinary calculi. Anhui Yike Daxue Xue Bao 43:573–575
Ou Yang JM, Zhou N (2004) Coordination chemistry basis of Chinese herbal medicine in treatment of urolithiasis. Zhong Cao Yao 5:579–582
Kuang L, He JH, Zhong GX, Ou’yang JM (2002) The study on the auxiliary effects of the traditional Chinese medicine after extracorporeal shockwave lithotripsy. Zhongguo Yi Yao Xue Bao 17:439–440
Zhu LJ, Wu S, Hu GX, You XM (2006) A clinical report of ESWL combined the traditional Chinese medicine in treating the urinary tract stones: 645 cases. Zhongguo Zhong Xi Yi Jie He Zazhi 26:660–661
Yang XX, Lei XC, Chang Q (2007) A report of Modified Peony Decoction plus in treating renal colic induced by calculous: 30 cases. Guizhou Zhongyi Xueyuan Xiao Bao 29:24–25
Wang X (2008) An Overview on treatment of urolithiasis. Zhongguo Shi Yong Yi Yao 3:189
Acknowledgments
We are grateful to Professors Zheng Qinglian and Fan Xinghua for technical assistance. This study was supported by a Grant-in-aid for the Sci-technical Development Project Foundation of Shaanxi Province, China (No. 2001K11-G7).
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Sheng, B., He, D., Zhao, J. et al. The protective effects of the traditional Chinese herbs against renal damage induced by extracorporeal shock wave lithotripsy: a clinical study. Urol Res 39, 89–97 (2011). https://doi.org/10.1007/s00240-010-0286-1
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DOI: https://doi.org/10.1007/s00240-010-0286-1