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Colquhounia root tablet in the treatment of idiopathic membranous nephropathy with subnephrotic proteinuria

  • Nephrology - Original Paper
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Abstract

Purpose

Idiopathic membranous nephropathy (IMN) is the most frequent global cause of nephrotic syndrome in non-diabetic people. In clinical practice, An effective and mild treatment for IMN patients with subnephrotic proteinuria has been adopted. Colquhounia root tablet (CRT) is a traditional Chinese medicine that is widely used in China to treat glomerulopathies. In this study, the effectiveness and safety of CRT in the treatment of IMN with subnephrotic proteinuria have been determined by reviewing the clinical records of 44 patients with IMN.

Methods

Retrospective analysis of IMN patients with subnephrotic proteinuria treated with CRT in combination with ACEI/ARB or ACEI/ARB alone. The remission rate (complete or partial remission) was the main outcome observed, and proteinuria, estimated glomerular filtration rate (eGFR), serum albumin levels, and adverse effects were the secondary outcomes.

Results

This clinical trial included 44 patients, and the overall remission rates at months 6, 9, and 12 after treatment were 68.2% versus 27.3% (p = 0.016), 72.7% versus 36.4% (p = 0.015), and 77.3% versus 36.4% (p = 0.006) in the treatment and control groups, respectively. The application of CRT treatment was an independent predictor of proteinuria remission (p = 0.024). In addition, in patients who were positive for phospholipase A2 receptor (PLA2R) antibodies, the overall remission rate was higher in the treatment group than in the control group after 9 months of treatment (75% versus 23.08%, p = 0.017).

Conclusion

This retrospective study illustrates that, based on supportive therapy, CRT could be effective in the treatment of IMN with subnephrotic proteinuria with a good safety profile at the same time.

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Data availability

The data included in this investigation are available from the corresponding author.

References

  1. Sethi S (2020) New ‘antigens’ in membranous nephropathy. J Am Soc Nephrol 32:2020071082

    Google Scholar 

  2. Couser WG (2017) Primary membranous nephropathy. Clin J Am Soc Nephro 12:983–997

    Article  CAS  Google Scholar 

  3. Davison AM, Cameron JS, Kerr DN, Ogg CS et al (1984) The natural history of renal function in untreated idiopathic membranous glomerulonephritis in adults. Clin Nephrol 2:61–67

    Google Scholar 

  4. Hladunewich MA, Troyanov S, Calafati J, Cattran DC (2009) The natural history of the non-nephrotic membranous nephropathy patient. Clin J Am Soc Nephro 9:1417–1422

    Article  Google Scholar 

  5. Bomback AS, Fervenza FC (2018) Membranous nephropathy: approaches to treatment. Am J Nephrol 47:30–42

    Article  CAS  PubMed  Google Scholar 

  6. Lv H, Jiang L, Zhu M, Li Y et al (2019) The genus Tripterygium: a phytochemistry and pharmacological review. Fitoterapia 137:104190

    Article  CAS  PubMed  Google Scholar 

  7. Wang X, Lang R, Liang Y, Zeng Q et al (2021) Traditional Chinese medicine in treating IgA nephropathy: from basic science to clinical research. J Transl Med 9:161–167

    Article  Google Scholar 

  8. Ma Z (2022) Repurposing a clinically approved prescription Colquhounia root tablet to treat diabetic kidney disease via suppressing PI3K/AKT/NF-kB activation. Chin Med-UK 17:2–13

    Article  CAS  Google Scholar 

  9. Zhong Y, Deng Y, Chen Y, Chuang PY et al (2013) Therapeutic use of traditional Chinese herbal medications for chronic kidney diseases. Kidney Int 84:1108–1118

    Article  PubMed  PubMed Central  Google Scholar 

  10. Levey AS, Inker LA, Coresh J (2014) GFR estimation: from physiology to public health. Am J Kidney Dis 63(5):820–834

    Article  PubMed  PubMed Central  Google Scholar 

  11. Hou JH, Zhu HX, Zhou ML, Le WB et al (2018) Changes in the spectrum of kidney diseases: an analysis of 40,759 biopsy-proven cases from 2003 to 2014 in China. Kidney Diseases 4:10–19

    Article  PubMed  Google Scholar 

  12. Feng Z, Liu W, Jiang HX (2020) How does herbal medicine treat idiopathic membranous nephropathy? Front Pharmacol 11:994

    Article  CAS  PubMed  PubMed Central  Google Scholar 

  13. Ronco P, Beck L, Debiec H, Fervenza FC et al (2021) Membranous nephropathy. Nat Rev Dis Primers 7(1):69

    Article  PubMed  Google Scholar 

  14. Cattran DC, Brenchley PE (2017) Membranous nephropathy: integrating basic science into improved clinical management. Kidney Int 91:566–574

    Article  CAS  PubMed  Google Scholar 

  15. McQuarrie EP, Stirling CM, Geddes CC (2012) Idiopathic membranous nephropathy and nephrotic syndrome: outcome in the era of evidence-based therapy. NDT 27:235–242

    CAS  PubMed  Google Scholar 

  16. Wang YN, Feng HY, Nie X, Zhang YM et al (2022) Recent advances in clinical diagnosis and pharmacotherapy options of membranous nephropathy. Front Pharmaco 13:907108

    Article  CAS  Google Scholar 

  17. Rovin BH, Adler SG, Barratt J (2021) KDIGO 2021 clinical practice guideline for the management of glomerular diseases. Kidney Int 100:271–276

    Article  Google Scholar 

  18. Hoxha E, Harendza S, Pinnschmidt H, Panzer U et al (2014) PLA2R antibody levels and clinical outcome in patients with membranous nephropathy and non-nephrotic range proteinuria under treatment with inhibitors of the renin-angiotensin system. PLoS ONE 9:110681

    Article  Google Scholar 

  19. Xue S, Wu T (2008) Chinese Herbal Medicine Tripterygium hypoglaucum hutch tablet for facial corticosteroid addiction dermatitis. J Altern Complem Med 14:619–624

    Article  Google Scholar 

  20. Zhao J, Zhang F, Xiao X, Wu Z et al (2021) Tripterygium hypoglaucum (Lévl.) hutch and its main bioactive components: recent advances in pharmacological activity, pharmacokinetics and potential toxicity. Front Pharmacol 12:715359

    Article  CAS  PubMed  PubMed Central  Google Scholar 

  21. Chen ZH, Qin WS, Zeng CH, Zheng CX et al (2010) Triptolide reduces proteinuria in experimental membranous nephropathy and protects against C5b-9-induced podocyte injury in vitro. Kidney Int 77:974–988

    Article  CAS  PubMed  Google Scholar 

  22. Wang S, Li R, He S, He L, et al. Tripterygium wilfordii glycosides upregulate the new anti-inflammatory cytokine IL-37 through ERK1/2 and p38 MAPK signal pathways. Evid Based Compl Alt. 2017; 9148523.

  23. Fang L, Lu B, Zhang L, Shen LW et al (2018) Effect of colquhounia root on the expression of Angptl2 and NF-κB in kidney of rats with diabetic nephropathy. World J Integr Tradit West Med 27:2749–2753

    Google Scholar 

  24. Zhou Y, Hong Y, Huang H (2016) Triptolide attenuates inflammatory response in membranous glomerulo nephritis rat via downregulation of NF-κB signaling pathway. Kidney Blood Press Res 10:23–35

    Google Scholar 

  25. Hongbing Z, Wei C (2005) Effect of colquhoumia root on the expression of transforming growth factor-β in mesangial proliferation glomerulonephritis model. J Huazhong U Sci-Med 25:412–415

    Article  Google Scholar 

  26. Miao H, Zhang Y, Yu X (2022) Membranous nephropathy: systems biology-based novel mechanism and traditional Chinese medicine therapy. Front Pharmacol 13:969930

    Article  CAS  PubMed  PubMed Central  Google Scholar 

  27. Chen Y, Deng Y, Ni Z, Chen N et al (2013) Efficacy and safety of traditional Chinese medicine (Shenqi particle) for patients with idiopathic membranous nephropathy: a multicenter randomized controlled clinical tria. Am J Kidney Dis 62:1068–1076

    Article  PubMed  Google Scholar 

  28. Liu S, Li X, Li H, Liang Q et al (2015) Comparison of Tripterygium wilfordii multiglycosides and tacrolimus in the treatment of idiopathic membranous nephropathy: a prospective cohort study. BMC Nephrol 4(16):200

    Article  Google Scholar 

  29. Shang SL, Cai GY, Duan SW (2018) Retrospective analysis of tacrolimus combined with Tripterygium wilfordii polyglycoside for treating idiopathic membranous nephropathy. BMC Nephrol 19(1):182

    Article  PubMed  PubMed Central  Google Scholar 

  30. Chen ZH (2010) Triptolide reduces proteinuria in experimental membranous nephropathy and protects against C5b-9-induced podocyte injury in vitro. Kidney Int 77(11):974–988

    Article  CAS  PubMed  Google Scholar 

  31. Zhou D, Liu Y (2016) Renal fibrosis in 2015: understanding the mechanisms of kidney fibrosis. Nat Rev Nephrol 12(2):68–70

    Article  CAS  PubMed  Google Scholar 

  32. Zhu B, Wang Y, Jardine M, Min J et al (2013) Tripterygium preparations for the treatment of CKD: a systematic review and meta-analysis. Am J Kidney Dis 62:515–530

    Article  CAS  PubMed  Google Scholar 

  33. Alsharhan L, Beck LH (2021) Membranous nephropathy: core curriculum 2021. Am J Kidney Dis 77:440–453

    Article  CAS  PubMed  Google Scholar 

Download references

Funding

This work was supported by the National Natural Science Foundation of China (No. 82070763), the Nature Science Foundation of Liaoning Province (No. 2020JH2/10300045).

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Authors and Affiliations

  1. The First Hospital of China Medical University, 155 Nanjing Street, Heping District, Shenyang, 110002, China

    Chunyan Xu, Tianhua Xu, Nan Liu, Linlin Liu, Li Sun, Xiaoli Li, Zilong Li & Li Yao

Authors
  1. Chunyan Xu
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  2. Tianhua Xu
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  3. Nan Liu
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  4. Linlin Liu
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  5. Li Sun
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  6. Xiaoli Li
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  7. Zilong Li
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  8. Li Yao
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Contributions

LY, LL, and LS conceived the hypothesis and designed the study. TX and NL collected the data. CX analyzed the data, visualized the figures and drafted the manuscript. XL, ZL, and LY revised the article. All authors read and approved the final manuscript.

Corresponding author

Correspondence to Li Yao.

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Conflict of interest

The authors affirm that they have no conflict of interest.

Ethical approval and consent to the participate

All procedures were in accordance with the standards of the Clinical Research Ethics Committee of the First Affiliated Hospital of China Medical University (2022-318) and the 1964 Declaration of Helsinki and its subsequent amendments. Everyone who took part in this study provided their informed permission.

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Xu, C., Xu, T., Liu, N. et al. Colquhounia root tablet in the treatment of idiopathic membranous nephropathy with subnephrotic proteinuria. Int Urol Nephrol 56, 699–706 (2024). https://doi.org/10.1007/s11255-023-03682-2

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