Chinese Herbal Medicine and Kidney Stones

Chinese Herbs.
image http://www.acupuncturehealingbristol.co.uk/id41.html

Kidney stone pain or ureteric colic is perhaps the most feared symptom of urolithiasis. People who experience it at its worst will do anything that they have been told will help in the passing kidney stones. Because of this fact there are many questionable products on the market which claim to pass kidney stones or dissolve kidney stones. From time to time I have reviewed some of the more prominent preparations.

There is a natural tendency to discount what we don't understand or were not trained to understand. I am no exception to this rule, having not been trained in traditional herbal medicine in a country where it is practiced. However I do believe the current upsurge in published studies utilizing traditional medicine has allowed for a bridging of knowledge between two worlds which are destined to collide. Clearly herbal medicine represents an area where there are opportunities to be exploited in development of new pharmaceutical agents. While practitioners of herbal medicine stand to gain valuable insight into the possible drug interactions which may occur between established pharmaceuticals and herbal preparations.

Therefore I was excited to note the following study published in the Brazilian Journal of Urology as recorded in the pubmed database. The purpose of the study was to assess the evidence based literature supporting the use of traditional Chinese medicine Kampo herbal and acupuncture in stone disease management.


Kampo literally means medicine from China and its a traditional japanese therapeutic system.

Kampo is said to have little or no side effects. If proven then this would be a significant advantage over traditional therapies for long term treatment of chronic kidney stones.
The herbs of Kampo are Chorei-to, Wullingsan, Kin Quan Cao, Nia Shi Mixture


Chorei-to
A mixture of herbs for nephritis and kidney stones. This mixture of herbs when examined together did not prevent formation of calcium phosphate crystals in an experimental model however individual herbs in the mixture had possible beneficial effect. Takusya decreased tissue calcium concentration and reduced tissue calcium oxalate in rat kidneys. Overall the constituents may increase solubility of calcium oxalate which is a good thing. The effect was not particularly strong in the experiments done.


Wullingsan

A combination of herbs thought to act as a diuretic. In laboratory studies wullingsan was able to reduce the rate of nucleation or the start of stone formation at specific dosages, however at higher doses the extract increased stone formation.


Jin Quan Cao
The main anti stone ingredient is called DS-T, it is believed to block urinary calcium excretion by either inhibiting the endogenous synthesis of 1-25(OH)2D from 1-alphaD3 in the kidney or by inhibiting the action of 1-25(OH)2D on increased intestinal absorption of Ca.

Niao Shi Mixture (NSM)

For more than 30 years, NSM has been used clinically at Guanganmen Hospital (Beijing, China) to treat urinary calculus and is very effective at preventing hydroxyproline stones.


Most of the studies were done in animals or in purely experimental models. It is possible that the herbs studied could have had a more pronounced and universally positive effects in humans. Properly designed studies of individual component vs placebo and separate components will be needed to produce the level of evidence needed for these preparations to be accepted into the western model of medicine. However the positive effects are intriguing to say the least


Previous review of Indian Herbal Medicines for Kidney stones
Previous review of URIFLOW

Green tea and Kidney Cancer News

Image by Dano

An abstract from the Journal Oncology Reports. has brought Green Tea back into the news yet again.

EGCG (epigallocatechin gallate), the major antioxidant found in green tea, has been shown to inhibit the growth of many tumor cells even inducing the tumor cells to spontaneously die by a process known as apoptosis. EGCG can inhibit one of the enzymes involved in DNA synthesis and repair and thus cause reactivation of genes that lead to this effect. The gene responsible is known as TFPI-2, a member of the Kunitz-type serine proteinase inhibitor family. Previous studies demonstrated that the expression of TFPI-2 and invasiveness of renal cell carcinoma had a negative correlation. TFPI-2 may induce tumor cell apoptosis in renal cell carcinoma. Lower expression of TFPI-2 in renal cell carcinoma may be induced by EGCG in green tea. This may explain the finding of the investigators where EGCG was shown to inhibit growth and induces apoptosis in renal cell carcinoma cell line. Although tests of invasiveness and metastasis did not indicate any significant differences between control and treatment group. The results suggest that EGCG inhibits growth and induces apoptosis in renal cell carcinoma through overexpression of TFPI-2 . This is the first report showing that EGCG is likely to be an effective agent for renal cell carcinoma.

Green tea's story continue to impress me.

Herbal Preparations to Dissolve Kidney Stones.

Herbs (Photo credit: KatieTT)

There is an ongoing study investigating the effectiveness and safety of 9 east indian herbs regarding their ability to dissolve kidney stones.

The herbal preparation being studied is known as Cystone. The components of Cystone are as follows.

Didymocarpus pedicellata

Based on the data obtained this herb has been used by traditional herbal practitioners. It is mainly indicated for the treatment of renal afflictions in general. One study has shown that it possesses powerful antioxidant effects which are capable of preventing damage to the kidney in the presence of specific toxins in an experimental fashion. This herb was also found to have an antiproliferative effect.

The Present data available suggests this herb is primarily an antioxidant. Another herbal antioxidant has previously been shown in similar laboratory settings to prevent stone formation. A vital step not shown in the study with Didymocarpus.

Bergenia ligulata

This is a widely used plant in South Asia, mainly India and Pakistan, as a traditional medicine for treatment of Kidney Stones.

One study available in the pubmed database has shown that extracts of this herb prevented calcium salt deposition in renal tubules. The treatment was associated with increased urine output as if due to a diuretic effect of the herb as well as an increase in urinary magnesium along with antioxidant effects.

Muitiple kidney stones composed of uric acid and a small amount of calcium oxalate. (Photo credit: Wikipedia)

This study supported a possible role of the use of this herb in preventing stone formation. But the diuretic effect may need to be accounted for as this could interact with other common medication to cause dehydration or predispose for acute renal failure in certain circumstances. Safety data was not available for human subjects.

Rubia cordifolia

Reportedly a herb used since ancient times. It is also known as Manjistha. It is used as a "detoxifier" in traditional medicine. The herb was found to be useful as an antibiotic agent active against at least 2 common species of bacteria. The exact dose is unknown.

Antibiotics are useful for the treatment of kidney stones only when infection is suspected. The antibacterial property of this herb may be of use however its exact spectrum of activity and interactions in humans remain unknown. It is believed that given the long history of use it is at least safe. However the more effective it is the more likely that care needs to be taken in terms of interaction with other mainstream drugs.

Cyperus scariosus

This herb has one study dating back to 1972 which showed anti-inflammatory activity as well as antioxidant activitiy


Achyranthes aspera

A. aspera has been cited in 27 studies within the pubmed database. It has been found to have anti parasitic effect, an antifertility effect and cardiac toxicity, inreases levels of thyroid function and antiinflammatory effects.

aspera study 1
aspera study 2
aspera study 3
aspera study 4

Onosma bracteatum

One study published in 1957 was a study of the phytochemical and pharmacological study of this herb is unavailable currently. However it is like that the herb has medicinal effects hence the reason for the study initially.

Kidney stone (Photo credit: Wikipedia)

No more useful evidence based information was available.

Vernonia cinerea

Was found to have potent antioxidant effects like many of the other herbal extracts.
Antimalaria effects as well as anti-inflammatory, antipyretic and analgesic effect.

In other words this maybe effective for treatment of pain and fever associated with stone passage.

Like most herbal preparations cystone is a mixed bag of herbs with multiple effects on multiple systems. THis herbal preparation seems somewhat more focused than some others in the areas of anti-inflammatory and antioxidant activity. The current ongoing trial is likely to show some positive effect. We of course would await the results of this trial to recommend such a product. As with most herbal products drug interaction will be of concern.

Colon Cleanse and The Kidney....to cleanse or not to cleanse?

photo credit: DoctorWho

The notion that the normal operation of the Gut results in pounds of un-excreted toxic materials, that accumulate over the lifetime of a human being is the basis of the colon cleansing industry that has sprung up nearly simultaneosusly world wide.

The theory behind colon cleansing hails back to the era of the greek and egyptian schools of medicine. Where autointoxication was believed to be responsible for all causes of disease. Autointoxication refers to an ancient theory that food enters the digestive system and rots giving rise to pus which enters the blood stream and causes all manner of ills. By 1919 the idea of autointoxication had run its course being debunked in the professional literature of the time. However despite the fact that there is no evidence of any benefit derived from the process, colon cleansing is still vigorously advertised as a mainstay alternative medicine treatment.

The claims below are derived from a popular website.

Toxins from the colon are supposedly able to:-

• Go to the brain and disturb mental function


• Go to the joints and cause pain and stiffness


• Weaken and stress the heart


• Go to the skin and cause blemishes, paleness, psoriasis, liver spots, wrinkles


• Irritate the lungs and cause foul breath


• Go to the muscles and cause weakness and terrible fatigue


• Rob you of your youth and ruin your health



Colon Cleanse Dietary Supplement (Photo credit: SpecialKRB)

While Colon Cleansing has the following positive effects.

• Controls your weight


• Increases your energy level


• Prevent constipation and disease of the colon


• Eliminates waste such as fatty tissue, cholesterol, cellulite, toxins, mucus, hardened fecal matter, harmful drug residue


• For the glow of health inside and out that shows with clear skin, bright eyes, and shiny hair

Those are some wonderful claims that would tempt anyone. But what is not mentioned are some of the dangers particularly if you have kidney disease. Oral phosphate preparations used for the purpose of cleansing the colon have recently been shown to cause sudden worsening of kidney function a state known as acute renal failure. This reduction in function tends to occur in two patterns based on the timing of onset of kidney failure after ingestion of the cleansing compound.

If symptoms begin to occur within 24 hours of ingestion (lethargy, confusion, seizure and sever muscular spasms) the course of the illness can be particularly stormy and even death may occur. On the other hand the patient may be fine after taking the cleansing compound for days to months after, however during this time an insidious process of calcification occurs within the kidney where much of the framework of the delicate tissues of the kidney are converted to a bone like substance. Death with this second pattern is unusual but patients go on to have chronic kidney disease.

Many proponents of colon cleansing will be quick to point out that they are aware of this problem with phosphate containing cleansers and would never use them for the purpose of cleansing the colon. They will then insist that proven herbal methods are available which are far more gentle and safer. They may also claim that by performing an enema using nothing but water the effect of the cleansing is guaranteed to be safe.

Unfortunately its still not as simple as that. Even irrigation with water has been shown to be dangerous, in fact perforation of the sigmoid colon has been documented to occur in patients with chronic renal failure who underwent irrigation enema's. Also instilling large volumes of dilute fluid into the colon of patients with kidney disease may not be a good idea. Dilution of the electrolytes ( important minerals within the blood) can result in abnormalities of cardiac function muscle spasm and abnormal brian function even seizures all of this for no proven benefit. Cleansing tends to lead to excessive excretion of fluid particularly if carried out regularly and this results in dehydration. Dehydration can give rise to acute renal failure as well.

I urge you to find some other way to find that glow of health inside that shows clear skin, bright eyes and shiny hair...please.

Herbal corner: Is green tea beneficial in kidney disease?

http://www.flickr.com/photos/tim7423/ / CC BY-NC 2.0

Many herbal preparations have been marketed to patients with all manner of diseases ranging from the common cold to incurable cancer. Green tea however has been the focus of much main stream research recently with several studies of its efficacy being published. It has been shown to be effective in weight loss particularly in men, it has been shown at high concentrations to inhibit the growth of cancer cells in the lab and population studies have demonstrated some positive results where high intake of the tea reduces the incidence of gastric and esophageal cancer. There is an old saying that goes where there is smoke there is also fire. Applied to this case it would seem that there is something in green tea with very useful effects something that maybe if extracted purified and amplified may lead to a new drug. The problems with herbs however is that there are frequently impure and have many thousands of chemicals that have to be sifted through to obtain the one with the most useful medicinal effect. There is also the possibility that some useful combination of active ingredients may interact in a manner based on relative concentrations that we do not yet understand to produce the desired effect. All of this is relatively complex business and will take quite a bit of time to sort out.

What we can report currently, is that one of the most useful compounds to be derived from green tea or Camellia sinensis is EGCG. This compound is one of the most potent antioxidants ever encountered. It is likely to play a significant role in the health benefits to be derived from green tea. Administration of this compound has been shown to reduce the growth of renal cell carcinoma by a new mechanism, which incidentally is the first report of its kind for green tea.

The extracts of green tea had previously been shown to protect the kidney from drug induced damage which is common with the administration of certain antibiotics such as gentamicin.

Green tea extract has also been shown to have a potential therapeutic benefit in diabetic induced kidney disease as published here.

All of the data so far is pointing towards benefit but is there any chance of harm, how does green tea interact with medication that patients with kidney disease may be taking?

People who take warfarin, a blood thinning medication should not drink green tea. Green tea contains vitamin K and as such should be avoided for this patient group. Green has an effect on platelets, it makes them less sticky. This effect also occurs with aspirin which means combining the two may cause bleeding. In patients with chronic kidney disease which is quite severe or in patient with an acute deterioration in kidney function this may be harmful as the platelets within the body which are responsible for preventing bleeding may already be dysfunctional, green tea may cause bleeding in such patients. As with any herbal treatment or new medication speak with your health care provider before initiating treatment even if the substance is considered a food supplement such as green tea is.

Herbal corner: Herbal medicine can be dangerous

While herbal medicine has been on the rise and some herbal remedies do have medicinal effect, we must be cautious about the use of herbs for which we have very limited data or of products that claim to be mixtures of multiple herbs with no method to actually confirm the constituents.

In 1993 investigators published in the lancet a review of a rapidly progressing kidney disease associated with scarring of the kidney, it was believed at that time that the only thing these two young women had in common was the consumption of slimming regimen including chinese herbs.

Upon further investigations seven other women were found to have progressed rapidly to require dialysis and again they had been taking the same chines herbs. Tissue samples of the kidney showed significant scarring of the flesh of the kidney while sparing the vascular components.

With the detailed investigation of this incident that followed two chinese herbs Stephania tetranda and Magnolia officinalis were identified as the culprits.

http://www.flickr.com/photos/raeallen/ / CC BY-NC-SA 2.0

http://www.flickr.com/photos/randihausken/ / CC BY-NC 2.0

Three years later a study investigating the mechanism of kidney damage in the prior incident revealed that aristocholic acid derived from the herbs in question was capable of damaging the DNA of kidney cells preventing them functioning, leading to kidney disease, they also concluded based on the mechanism of damage that cancers could occur based on prolonged exposure to the offending agents.

In 2000 another article published in the new england journal of medicine concluded cancer is high among patients with chinese herb induced kidney disease. Several animal studies were done and the primary component of the herbs aristocholic acid was found to induce tumours in rodent. Now all patients who had kidney disease because of these herbs must have routine checkups to screen for the devlopment of cancers even years later.

Due to the rapid evolution of the disease from taking the herbs to requiring dialysis in three months, chinese herb nephropathy is difficult to effectively treat. High doses of steroid have been tried with some success however.

In this case carefully reading the ingredients could help a whole lot, however just discussing the supplements with your physician may actually save your life.

Herbal corner: Herbal medicine can be dangerous

While herbal medicine has been on the rise and some herbal remedies do have medicinal effect, we must be cautious about the use of herbs for which we have very limited data or of products that claim to be mixtures of multiple herbs with no method to actually confirm the constituents.

In 1993 investigators published in the lancet a review of a rapidly progressing kidney disease associated with scarring of the kidney, it was believed at that time that the only thing these two young women had in common was the consumption of slimming regimen including chinese herbs.

Upon further investigations seven other women were found to have progressed rapidly to require dialysis and again they had been taking the same chines herbs. Tissue samples of the kidney showed significant scarring of the flesh of the kidney while sparing the vascular components.

With the detailed investigation of this incident that followed two chinese herbs Stephania tetranda and Magnolia officinalis were identified as the culprits.

http://www.flickr.com/photos/raeallen/ / CC BY-NC-SA 2.0

http://www.flickr.com/photos/randihausken/ / CC BY-NC 2.0

Three years later a study investigating the mechanism of kidney damage in the prior incident revealed that aristocholic acid derived from the herbs in question was capable of damaging the DNA of kidney cells preventing them functioning, leading to kidney disease, they also concluded based on the mechanism of damage that cancers could occur based on prolonged exposure to the offending agents.

In 2000 another article published in the new england journal of medicine concluded cancer is high among patients with chinese herb induced kidney disease. Several animal studies were done and the primary component of the herbs aristocholic acid was found to induce tumours in rodent. Now all patients who had kidney disease because of these herbs must have routine checkups to screen for the devlopment of cancers even years later.

Due to the rapid evolution of the disease from taking the herbs to requiring dialysis in three months, chinese herb nephropathy is difficult to effectively treat. High doses of steroid have been tried with some success however.

In this case carefully reading the ingredients could help a whole lot, however just discussing the supplements with your physician may actually save your life.