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Kimak A, Żebrowska A. Therapeutic Approach in Pigmented Purpuric Dermatoses-A Scoping Review. Int J Mol Sci 2024; 25:2644. [PMID: 38473891 DOI: 10.3390/ijms25052644] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/25/2024] [Revised: 02/17/2024] [Accepted: 02/19/2024] [Indexed: 03/14/2024] Open
Abstract
Pigmented purpuric dermatoses (PPD) encompass a group of chronic skin conditions characterized by the presence of petechiae, purpura, and pigmentation changes. While generally benign, these dermatoses can be persistent and aesthetically bothersome. Key clinical features include red to brownish patches with a distinctive "cayenne pepper" appearance, predominantly localized on the lower extremities, particularly the shins. Subtypes include Schamberg disease, Majocchi's disease, Gougerot-Blum disease, Ducas and Kapetanakis pigmented purpura, and lichen aureus. Diagnosis relies primarily on clinical evaluation of skin lesions, with biopsy as a confirmatory tool. Although the exact cause of PPD remains unclear, capillary fragility and red blood cell extravasation are implicated. Treatment strategies for PPD aim to alleviate symptoms, considering the generally benign and chronic nature of the condition. As there is no standardized treatment, various methods with varying efficacy are employed. After searching SCOPUS and PubMed databases, we assessed 42 original articles to present current knowledge regarding therapy of PPD. This review will compare treatment approaches specifically in Schamberg disease and other manifestations of pigmented purpuric dermatoses.
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Affiliation(s)
- Agnieszka Kimak
- Department of Dermatology and Venereology, Medical University of Lodz, Hallera 1, 90-647 Lodz, Poland
| | - Agnieszka Żebrowska
- Department of Dermatology and Venereology, Medical University of Lodz, Hallera 1, 90-647 Lodz, Poland
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2
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Rayego-Mateos S, Rodrigues-Diez RR, Fernandez-Fernandez B, Mora-Fernández C, Marchant V, Donate-Correa J, Navarro-González JF, Ortiz A, Ruiz-Ortega M. Targeting inflammation to treat diabetic kidney disease: the road to 2030. Kidney Int 2023; 103:282-296. [PMID: 36470394 DOI: 10.1016/j.kint.2022.10.030] [Citation(s) in RCA: 34] [Impact Index Per Article: 34.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/21/2022] [Revised: 10/05/2022] [Accepted: 10/31/2022] [Indexed: 12/07/2022]
Abstract
Diabetic kidney disease (DKD) is one of the fastest growing causes of chronic kidney disease and associated morbidity and mortality. Preclinical research has demonstrated the involvement of inflammation in its pathogenesis and in the progression of kidney damage, supporting clinical trials designed to explore anti-inflammatory strategies. However, the recent success of sodium-glucose cotransporter-2 inhibitors and the nonsteroidal mineralocorticoid receptor antagonist finerenone has changed both guidelines and standard of care, rendering obsolete older studies directly targeting inflammatory mediators and the clinical development was discontinued for most anti-inflammatory drugs undergoing clinical trials for DKD in 2016. Given the contribution of inflammation to the pathogenesis of DKD, we review the impact on kidney inflammation of the current standard of care, therapies undergoing clinical trials, or repositioned drugs for DKD. Moreover, we review recent advances in the molecular regulation of inflammation in DKD and discuss potential novel therapeutic strategies with clinical relevance. Finally, we provide a road map for future research aimed at integrating the growing knowledge on inflammation and DKD into clinical practice to foster improvement of patient outcomes.
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Affiliation(s)
- Sandra Rayego-Mateos
- Cellular Biology in Renal Diseases Laboratory, IIS-Fundación Jiménez Díaz, Universidad Autónoma, Madrid, Spain; Ricord2040, Instituto de Salud Carlos II, Spain
| | - Raul R Rodrigues-Diez
- Ricord2040, Instituto de Salud Carlos II, Spain; Translational Immunology, Instituto de Investigación Sanitaria del Principado de Asturias ISPA, Oviedo, Asturias, Spain
| | - Beatriz Fernandez-Fernandez
- Ricord2040, Instituto de Salud Carlos II, Spain; Division of Nephrology and Hypertension, IIS-Fundación Jiménez Díaz-Universidad Autónoma, Madrid, Spain
| | - Carmen Mora-Fernández
- Ricord2040, Instituto de Salud Carlos II, Spain; Research Unit, University Hospital Nuestra Señora de Candelaria, Santa Cruz de Tenerife, Spain
| | - Vanessa Marchant
- Cellular Biology in Renal Diseases Laboratory, IIS-Fundación Jiménez Díaz, Universidad Autónoma, Madrid, Spain; Ricord2040, Instituto de Salud Carlos II, Spain
| | - Javier Donate-Correa
- Ricord2040, Instituto de Salud Carlos II, Spain; Research Unit, University Hospital Nuestra Señora de Candelaria, Santa Cruz de Tenerife, Spain
| | - Juan F Navarro-González
- Ricord2040, Instituto de Salud Carlos II, Spain; Research Unit, University Hospital Nuestra Señora de Candelaria, Santa Cruz de Tenerife, Spain; Nephrology Service, University Hospital Nuestra Señora de Candelaria, Santa Cruz de Tenerife, Spain
| | - Alberto Ortiz
- Ricord2040, Instituto de Salud Carlos II, Spain; Division of Nephrology and Hypertension, IIS-Fundación Jiménez Díaz-Universidad Autónoma, Madrid, Spain
| | - Marta Ruiz-Ortega
- Cellular Biology in Renal Diseases Laboratory, IIS-Fundación Jiménez Díaz, Universidad Autónoma, Madrid, Spain; Ricord2040, Instituto de Salud Carlos II, Spain.
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3
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Donate-Correa J, Sanchez-Niño MD, González-Luis A, Ferri C, Martín-Olivera A, Martín-Núñez E, Fernandez-Fernandez B, Tagua VG, Mora-Fernández C, Ortiz A, Navarro-González JF. Repurposing drugs for highly prevalent diseases: pentoxifylline, an old drug and a new opportunity for diabetic kidney disease. Clin Kidney J 2022; 15:2200-2213. [PMID: 36381364 PMCID: PMC9664582 DOI: 10.1093/ckj/sfac143] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/17/2022] [Indexed: 11/30/2022] Open
Abstract
Diabetic kidney disease is one of the most frequent complications in patients with diabetes and constitutes a major cause of end-stage kidney disease. The prevalence of diabetic kidney disease continues to increase as a result of the growing epidemic of diabetes and obesity. Therefore, there is mounting urgency to design and optimize novel strategies and drugs that delay the progression of this pathology and contain this trend. The new approaches should go beyond the current therapy focussed on the control of traditional risk factors such as hyperglycaemia and hypertension. In this scenario, drug repurposing constitutes an economic and feasible approach based on the discovery of useful activities for old drugs. Pentoxifylline is a nonselective phosphodiesterase inhibitor currently indicated for peripheral artery disease. Clinical trials and meta-analyses have shown renoprotection secondary to anti-inflammatory and antifibrotic effects in diabetic patients treated with this old known drug, which makes pentoxifylline a candidate for repurposing in diabetic kidney disease.
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Affiliation(s)
- Javier Donate-Correa
- Unidad de Investigación, Hospital Universitario Nuestra Señora de Candelaria, Santa Cruz de Tenerife, Spain
- GEENDIAB (Grupo Español para el estudio de la Nefropatía Diabética), Sociedad Española de Nefrología, Santander, Spain
- RICORS2040 (RD21/0005/0013), Instituto de Salud Carlos III, Madrid, Spain
| | - María Dolores Sanchez-Niño
- Departamento de Nefrología e Hipertensión, IIS-Fundación Jiménez Díaz y Facultad de Medicina, Universidad Autónoma de Madrid, Madrid, Spain
| | - Ainhoa González-Luis
- Unidad de Investigación, Hospital Universitario Nuestra Señora de Candelaria, Santa Cruz de Tenerife, Spain
- Escuela de doctorado, Universidad de La Laguna
| | - Carla Ferri
- Unidad de Investigación, Hospital Universitario Nuestra Señora de Candelaria, Santa Cruz de Tenerife, Spain
- Escuela de doctorado, Universidad de La Laguna
| | - Alberto Martín-Olivera
- Unidad de Investigación, Hospital Universitario Nuestra Señora de Candelaria, Santa Cruz de Tenerife, Spain
- Escuela de doctorado, Universidad de La Laguna
| | - Ernesto Martín-Núñez
- Unidad de Investigación, Hospital Universitario Nuestra Señora de Candelaria, Santa Cruz de Tenerife, Spain
- RICORS2040 (RD21/0005/0013), Instituto de Salud Carlos III, Madrid, Spain
| | - Beatriz Fernandez-Fernandez
- Departamento de Nefrología e Hipertensión, IIS-Fundación Jiménez Díaz y Facultad de Medicina, Universidad Autónoma de Madrid, Madrid, Spain
- RICORS2040 (RD21/0005/0001), Instituto de Salud Carlos III, Madrid, Spain
| | - Víctor G Tagua
- Unidad de Investigación, Hospital Universitario Nuestra Señora de Candelaria, Santa Cruz de Tenerife, Spain
| | - Carmen Mora-Fernández
- Unidad de Investigación, Hospital Universitario Nuestra Señora de Candelaria, Santa Cruz de Tenerife, Spain
- GEENDIAB (Grupo Español para el estudio de la Nefropatía Diabética), Sociedad Española de Nefrología, Santander, Spain
- RICORS2040 (RD21/0005/0013), Instituto de Salud Carlos III, Madrid, Spain
| | - Alberto Ortiz
- Departamento de Nefrología e Hipertensión, IIS-Fundación Jiménez Díaz y Facultad de Medicina, Universidad Autónoma de Madrid, Madrid, Spain
- RICORS2040 (RD21/0005/0001), Instituto de Salud Carlos III, Madrid, Spain
| | - Juan F Navarro-González
- Unidad de Investigación, Hospital Universitario Nuestra Señora de Candelaria, Santa Cruz de Tenerife, Spain
- GEENDIAB (Grupo Español para el estudio de la Nefropatía Diabética), Sociedad Española de Nefrología, Santander, Spain
- RICORS2040 (RD21/0005/0013), Instituto de Salud Carlos III, Madrid, Spain
- Servicio de Nefrología, Hospital Universitario Nuestra Señora de Candelaria, Santa Cruz de Tenerife, Spain
- Instituto de Tecnologías Biomédicas, Universidad de La Laguna, Santa Cruz de Tenerife, Spain
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Moosaie F, Rabizadeh S, Fallahzadeh A, Sheikhy A, Meysamie A, Dehghani Firouzabadi F, Nakhjavani M, Esteghamati A. Effects of Pentoxifylline on Serum Markers of Diabetic Nephropathy in Type 2 Diabetes. Diabetes Ther 2022; 13:1023-1036. [PMID: 35380410 PMCID: PMC9076784 DOI: 10.1007/s13300-022-01250-y] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/30/2021] [Accepted: 03/08/2022] [Indexed: 11/10/2022] Open
Abstract
OBJECTIVE To investigate the effects of pentoxifylline (PTX) in combination with losartan compared to the high dose of losartan alone on serum markers of diabetic nephropathy such as HSP70, copeptin, CRP, and TNFα in patients with type 2 diabetes and nephropathy. METHODS A single-center, randomized, double-blind, open-label clinical trial was conducted. Sixty-two patients were eligible and allocated to "PTX + losartan" and "high-dose losartan" arms of the trial using software for random number generation. The first arm received 400 mg PTX two times a day (BD) plus 50 mg losartan daily, while the second arm received 50 mg losartan two times a day (BD) for 12 weeks. Comparison of the biomarkers' levels before and after treatment was done using paired sample t test variance. ANCOVA was applied to evaluate the comparative efficacy of the two interventions. The effect size was calculated and reported for each biomarker. RESULTS Urine albumin excretion (UAE), hs-CRP, and HbA1c significantly decreased in both trial arms compared to the baseline measures. Copeptin and TNFα showed significant differences (after vs before) only in the losartan group (p = 0.017 and p = 0.043, respectively). The losartan arm was more successful in reducing TNFα, copeptin, HSP70, systolic blood pressure (SBP), and diastolic blood pressure (DBP) values (p = 0.045, effect size = 7.3%; p = 0.018, effect size 10.1%; p = 0.046, effect size 4.7%, p = 0.001, effect size 23%; p = 0.012, effect size 10.2%, respectively) and the PTX arm was associated with a superior reduction of UAE and hs-CRP levels (p = 0.018, effect size 9.1%; p = 0.028, effect size 9.2%, respectively). CONCLUSION Add-on PTX to losartan may have more effective anti-inflammatory and anti-albuminuric roles and therefore may be more applicable in the management of diabetic nephropathy compared with high-dose losartan alone. TRAIL REGISTRATION Trial number IRCT 20121104011356N10.
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Affiliation(s)
- Fatemeh Moosaie
- Endocrinology and Metabolism Research Center (EMRC), Vali-Asr Hospital, School of Medicine, Tehran University of Medical Sciences, P.O. Box 13145-784, Tehran, Iran
| | - Soghra Rabizadeh
- Endocrinology and Metabolism Research Center (EMRC), Vali-Asr Hospital, School of Medicine, Tehran University of Medical Sciences, P.O. Box 13145-784, Tehran, Iran
| | - Aida Fallahzadeh
- Endocrinology and Metabolism Research Center (EMRC), Vali-Asr Hospital, School of Medicine, Tehran University of Medical Sciences, P.O. Box 13145-784, Tehran, Iran
| | - Ali Sheikhy
- Endocrinology and Metabolism Research Center (EMRC), Vali-Asr Hospital, School of Medicine, Tehran University of Medical Sciences, P.O. Box 13145-784, Tehran, Iran
| | - Alipasha Meysamie
- Department of Community Medicine, Tehran University of Medical Sciences, Tehran, Iran
| | - Fatemeh Dehghani Firouzabadi
- Endocrinology and Metabolism Research Center (EMRC), Vali-Asr Hospital, School of Medicine, Tehran University of Medical Sciences, P.O. Box 13145-784, Tehran, Iran
| | - Manouchehr Nakhjavani
- Endocrinology and Metabolism Research Center (EMRC), Vali-Asr Hospital, School of Medicine, Tehran University of Medical Sciences, P.O. Box 13145-784, Tehran, Iran
| | - Alireza Esteghamati
- Endocrinology and Metabolism Research Center (EMRC), Vali-Asr Hospital, School of Medicine, Tehran University of Medical Sciences, P.O. Box 13145-784, Tehran, Iran.
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5
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Panahi-Shokouh M, Moghaddas A, Badri S, Jabalameli S, Momenzadeh M, Mehrzad V, Ashrafi F. Pentoxifylline in Prevention of Amphotericin B-induced Nephrotoxicity and Electrolyte Abnormalities. J Res Pharm Pract 2021; 9:135-139. [PMID: 33489981 PMCID: PMC7808184 DOI: 10.4103/jrpp.jrpp_20_98] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/12/2020] [Accepted: 08/02/2020] [Indexed: 11/12/2022] Open
Abstract
Objective: Amphotericin B is an antifungal agent used to treat serious fungal infections mainly in critically ill patients. Despite its adverse effects including renal toxicity and electrolyte imbalances, amphotericin B remains one of the best choices for antifungal treatment. Information from animal studies has provided a strong scientific basis for the use of pentoxifylline as lowering nephroprotective agent. The present study was designed to evaluate the efficacy of pentoxifylline in preventing renal toxicity and electrolytes imbalances induced by amphotericin B. Methods: This study was conducted as a randomized controlled trial on 44 patients admitted to Sayyedoshohada Hospital, Isfahan, Iran, from October 2016 to August 2018. Patients were assigned to one of the two groups: Pentoxifylline, 400 mg twice a day, or matching placebo, from the 1st day of amphotericin B therapy till minimum of 7 days. All patients' information including lab data (serum and urine levels of Mg, Na, and K, serum creatinine level, blood urea nitrogen [BUN] and urinary creatinine excretion) were gathered at the time of drug initiation and during the study period. The results were analyzed by SPSS v. 20 software and Repeated measures test was used to assess the differences between groups Findings: This study did not show any significant differences between the two groups in terms of all the assessed variables, including serum and urinary levels of electrolytes, and creatinine, as well as the number of cases presented acute kidney injury during the study period. Conclusion: Despite the positive effects of pentoxifylline in preventing renal complications in previous studies, this study could not show a definitive result in salt wasting or renal damage induced by amphotericin B. So, Designing robust studies with more included samples would be valuable.
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Affiliation(s)
- Mahsa Panahi-Shokouh
- Department of Clinical Pharmacy and Pharmacy Practice, Isfahan University of Medical Sciences, Isfahan, Iran
| | - Azadeh Moghaddas
- Department of Clinical Pharmacy and Pharmacy Practice, Isfahan University of Medical Sciences, Isfahan, Iran
| | - Shirinsadat Badri
- Department of Clinical Pharmacy and Pharmacy Practice, Isfahan University of Medical Sciences, Isfahan, Iran.,Isfahan Kidney Diseases Research Center, Isfahan University of Medical Sciences, Isfahan, Iran
| | - Saeedeh Jabalameli
- Department of Clinical Pharmacy and Pharmacy Practice, Isfahan University of Medical Sciences, Isfahan, Iran
| | - Mahnaz Momenzadeh
- Department of Clinical Pharmacy and Pharmacy Practice, Isfahan University of Medical Sciences, Isfahan, Iran
| | - Valiollah Mehrzad
- Department of Oncology/Hematology, Isfahan University of Medical Sciences, Isfahan, Iran
| | - Farzaneh Ashrafi
- Department of Oncology/Hematology, Isfahan University of Medical Sciences, Isfahan, Iran
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Inacio MD, Costa MC, Lima TFO, Figueiredo ID, Motta BP, Spolidorio LC, Assis RP, Brunetti IL, Baviera AM. Pentoxifylline mitigates renal glycoxidative stress in obese mice by inhibiting AGE/RAGE signaling and increasing glyoxalase levels. Life Sci 2020; 258:118196. [PMID: 32763295 DOI: 10.1016/j.lfs.2020.118196] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/27/2020] [Revised: 07/30/2020] [Accepted: 07/31/2020] [Indexed: 12/12/2022]
Abstract
AIM The pharmacological properties of pentoxifylline have been re-evaluated, particularly in chronic kidney disease in diabetes, favored by its anti-inflammatory action. Definitive evidences of renal outcomes are lacking, which indicates the need for investigation of novel mechanisms of action of pentoxifylline. We postulated that components associated with the metabolism of advanced glycation end products (AGEs) may be modulated by pentoxifylline, which consequently decreases the detrimental effects of obesity on kidneys. MAIN METHODS C57BL-6J mice were fed a high-fat diet for 14 weeks and treated with 50 mg/kg pentoxifylline during the last 7 weeks. Changes in the renal levels of AGE metabolism-associated components were investigated, with particular focus on the receptor for AGEs (RAGE), its downstream components, and components related to AGE detoxification, including glyoxalase 1 (GLO 1). KEY FINDINGS Pentoxifylline reduced body weight gain, improved insulin sensitivity and glucose tolerance, downregulated biomarkers of glycoxidative stress, and enhanced plasma paraoxonase 1 activity. In the kidneys, pentoxifylline inhibited glomerular expansion, lipid deposition, reduced pro-inflammatory cytokine levels, and induced the activation of AMP-activated protein kinase. Pentoxifylline inhibited the renal accumulation of AGEs and reduced the levels of RAGE and its downstream components, and consequently mitigated oxidative stress and apoptosis. Pentoxifylline also increased the renal levels of GLO 1 and the activities of antioxidant enzymes. Urinary albumin levels were observed to be lowered, which reconfirmed the antialbuminuric effects of pentoxifylline. SIGNIFICANCE The novel mechanisms of action help explain the renoprotective effects of pentoxifylline and the attenuation of obesity-associated renal complications related to glycoxidative stress.
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Affiliation(s)
- Maiara Destro Inacio
- São Paulo State University (Unesp), School of Pharmaceutical Sciences, Department of Clinical Analysis, Araraquara, São Paulo, Brazil
| | - Mariana Campos Costa
- São Paulo State University (Unesp), School of Pharmaceutical Sciences, Department of Clinical Analysis, Araraquara, São Paulo, Brazil
| | - Tayra Ferreira Oliveira Lima
- São Paulo State University (Unesp), School of Pharmaceutical Sciences, Department of Clinical Analysis, Araraquara, São Paulo, Brazil
| | - Ingrid Delbone Figueiredo
- São Paulo State University (Unesp), School of Pharmaceutical Sciences, Department of Clinical Analysis, Araraquara, São Paulo, Brazil
| | - Bruno Pereira Motta
- São Paulo State University (Unesp), School of Pharmaceutical Sciences, Department of Clinical Analysis, Araraquara, São Paulo, Brazil
| | - Luís Carlos Spolidorio
- São Paulo State University (Unesp), Araraquara School of Dentistry, Department of Physiology and Pathology, Araraquara, São Paulo, Brazil
| | - Renata Pires Assis
- São Paulo State University (Unesp), School of Pharmaceutical Sciences, Department of Clinical Analysis, Araraquara, São Paulo, Brazil; Paulista University (UNIP), Institute of Health Sciences, Araraquara, São Paulo, Brazil
| | - Iguatemy Lourenço Brunetti
- São Paulo State University (Unesp), School of Pharmaceutical Sciences, Department of Clinical Analysis, Araraquara, São Paulo, Brazil
| | - Amanda Martins Baviera
- São Paulo State University (Unesp), School of Pharmaceutical Sciences, Department of Clinical Analysis, Araraquara, São Paulo, Brazil.
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Hung PH, Lin CH, Hung KY, Muo CH, Chung MC, Chang CH, Chung CJ. Clinical burden of autosomal dominant polycystic kidney disease. Aging (Albany NY) 2020; 12:3899-3910. [PMID: 32096480 PMCID: PMC7066921 DOI: 10.18632/aging.102858] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/31/2019] [Accepted: 02/08/2020] [Indexed: 11/25/2022]
Abstract
There are no specific therapies for autosomal dominant polycystic kidney disease (ADPKD), and clinical data evaluating the effects of non-specific therapies on ADPKD patients are scarce. We therefore evaluated those effects using data from a longitudinal health insurance database collected from 2000-2010. We individually selected patients with and without ADPKD from inpatient data files as well as from the catastrophic illness registry in Taiwan based on 1:5 frequency matching for sex, age, and index year. The hazard ratios (HR) of all-cause mortality, ischemic stroke, hemorrhagic stroke and end-stage renal disease (ESRD) in ADPKD inpatients were elevated as compared to the controls. Similarly, ADPKD patients from the catastrophic illness registry had an increased risk of hemorrhagic stroke and ESRD. Allopurinol users also had an increased risk of all-cause mortality. The HR for developing ESRD after medication exposure was 0.47-fold for statin and 1.93-fold for pentoxifylline. These results reveal that patients with ADPKD (either inpatient or from the catastrophic illness registry) are at elevated risk for hemorrhagic stroke and ESRD, and suggest that allopurinol and pentoxifylline should not be prescribed to ADPKD patients due to possible adverse effects.
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Affiliation(s)
- Peir-Haur Hung
- Department of Internal Medicine, Ditmanson Medical Foundation Chiayi Christian Hospital, Chia-Yi, Taiwan.,Department of Applied Life Science and Health, Chia-Nan University of Pharmacy and Science, Tainan, Taiwan
| | - Chien-Hung Lin
- Division of Pediatric Immunology and Nephrology, Department of Pediatrics, Taipei Veterans General Hospital, Taipei, Taiwan.,Institute of Clinical Medicine, National Yang-Ming University, Taipei, Taiwan.,Department of Pediatrics, Zhongxing Branch, Taipei City Hospital, Taipei, Taiwan.,College of Science and Engineering, Fu Jen Catholic University, New Taipei, Taiwan
| | - Kuan-Yu Hung
- Department of Internal Medicine, National Taiwan University Hospital, Taipei, Taiwan
| | - Chih-Hsin Muo
- Management Office for Health Data, China Medical University Hospital, Taichung, Taiwan
| | - Mu-Chi Chung
- Division of Nephrology, Department of Medicine, Taichung Veterans General Hospital, Taichung, Taiwan
| | - Chao-Hsiang Chang
- Department of Urology, China Medical University Hospital, Taichung, Taiwan
| | - Chi-Jung Chung
- Department of Medical Research, China Medical University Hospital, Taichung, Taiwan.,Department of Public Health, China Medical University, Taichung, Taiwan
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8
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Thajudeen B, Murugapandian S, Roy-Chaudhury P. Emerging Therapies. CHRONIC RENAL DISEASE 2020:1189-1205. [DOI: 10.1016/b978-0-12-815876-0.00072-3] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 07/19/2023]
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9
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Donate-Correa J, Tagua VG, Ferri C, Martín-Núñez E, Hernández-Carballo C, Ureña-Torres P, Ruiz-Ortega M, Ortiz A, Mora-Fernández C, Navarro-González JF. Pentoxifylline for Renal Protection in Diabetic Kidney Disease. A Model of Old Drugs for New Horizons. J Clin Med 2019; 8:jcm8030287. [PMID: 30818852 PMCID: PMC6463074 DOI: 10.3390/jcm8030287] [Citation(s) in RCA: 24] [Impact Index Per Article: 4.8] [Reference Citation Analysis] [Abstract] [Key Words] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/31/2019] [Revised: 02/21/2019] [Accepted: 02/22/2019] [Indexed: 12/26/2022] Open
Abstract
Diabetic kidney disease is one of the most relevant complications in diabetes mellitus patients, which constitutes the main cause of end-stage renal disease in the western world. Delaying the progression of this pathology requires new strategies that, in addition to the control of traditional risk factors (glycemia and blood pressure), specifically target the primary pathogenic mechanisms. Nowadays, inflammation is recognized as a critical novel pathogenic factor in the development and progression of renal injury in diabetes mellitus. Pentoxifylline is a nonspecific phosphodiesterase inhibitor with rheologic properties clinically used for more than 30 years in the treatment of peripheral vascular disease. In addition, this compound also exerts anti-inflammatory actions. In the context of diabetic kidney disease, pentoxifylline has shown significant antiproteinuric effects and a delay in the loss of estimated glomerular filtration rate, although at the present time there is no definitive evidence regarding renal outcomes. Moreover, recent studies have reported that this drug can be associated with a positive impact on new factors related to kidney health, such as Klotho. The use of pentoxifylline as renoprotective therapy for patients with diabetic kidney disease represents a new example of drug repositioning.
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Affiliation(s)
- Javier Donate-Correa
- Unidad de Investigación, Hospital Universitario Nuestra Señora de Candelaria, 38010 Santa Cruz de Tenerife, Spain.
- GEENDIAB (Grupo Español para el estudio de la Nefropatía Diabética), Sociedad Española de Nefrología, 39008 Santander, Spain.
| | - Víctor G Tagua
- Unidad de Investigación, Hospital Universitario Nuestra Señora de Candelaria, 38010 Santa Cruz de Tenerife, Spain.
| | - Carla Ferri
- Unidad de Investigación, Hospital Universitario Nuestra Señora de Candelaria, 38010 Santa Cruz de Tenerife, Spain.
| | - Ernesto Martín-Núñez
- Unidad de Investigación, Hospital Universitario Nuestra Señora de Candelaria, 38010 Santa Cruz de Tenerife, Spain.
- GEENDIAB (Grupo Español para el estudio de la Nefropatía Diabética), Sociedad Española de Nefrología, 39008 Santander, Spain.
| | | | - Pablo Ureña-Torres
- Department of Dialyisis, AURA Nord, Saint Ouen, 93400 Paris, France.
- Department of Renal Physiology, Necker Hospital, University Paris Descartes, 75006 Paris, France.
| | - Marta Ruiz-Ortega
- Laboratorio de Biología Celular en Enfermedades Renales, Universidad Autónoma Madrid, IIS-Fundación Jiménez Díaz, Madrid, 28004, Spain.
- REDINREN (Red de Investigación Renal-RD16/0009/0007), Instituto de Salud Carlos III, Madrid, 28029, Spain.
| | - Alberto Ortiz
- Departamento de Nefrología e Hipertensión, IIS-Fundación Jiménez Díaz y Facultad de Medicina, Universidad Autónoma de Madrid, 28049 Madrid, Spain.
- REDINREN (Red de Investigación Renal-RD16/0009/0001), Instituto de Salud Carlos III, 28029 Madrid, Spain.
| | - Carmen Mora-Fernández
- Unidad de Investigación, Hospital Universitario Nuestra Señora de Candelaria, 38010 Santa Cruz de Tenerife, Spain.
- GEENDIAB (Grupo Español para el estudio de la Nefropatía Diabética), Sociedad Española de Nefrología, 39008 Santander, Spain.
- REDINREN (Red de Investigación Renal-RD16/0009/0022), Instituto de Salud Carlos III, 28029 Madrid, Spain.
| | - Juan F Navarro-González
- Unidad de Investigación, Hospital Universitario Nuestra Señora de Candelaria, 38010 Santa Cruz de Tenerife, Spain.
- GEENDIAB (Grupo Español para el estudio de la Nefropatía Diabética), Sociedad Española de Nefrología, 39008 Santander, Spain.
- REDINREN (Red de Investigación Renal-RD16/0009/0022), Instituto de Salud Carlos III, 28029 Madrid, Spain.
- Servicio de Nefrología, Hospital Universitario Nuestra Señora de Candelaria, 38010 Santa Cruz de Tenerife, Spain.
- Instituto de Tecnologías Biomédicas, Universidad de La Laguna, 38010 Santa Cruz de Tenerife, Spain.
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10
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Jalili C, Moradi D, Roshankhah S, Salahshoor MR. Effect of pentoxifylline on kidney damage induced by nitrosamine in male rats. Res Pharm Sci 2019; 14:64-73. [PMID: 30936934 PMCID: PMC6407339 DOI: 10.4103/1735-5362.251854] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/07/2023] Open
Abstract
Nitrosamines are well-known carcinogenic agents. Humans are exposed to nitrosamines in various ways, the most important of which is the diet. Pentoxifylline is a xanthine derivative, which is used as a drug that inhibits inflammatory factors, reduces blood viscosity, improves peripheral blood flow, and increases oxygenation of tissue. This study was designed to evaluate the effects of pentoxifylline against damage induced by nitrosamine to the kidneys of rats. In this study, 48 male rats were randomly assigned to 8 groups: control normal group and nitrosamine control treated group (40 mg/kg); pentoxifylline groups (25, 50, 100 mg/kg) and nitrosamine + pentoxifylline treated groups (25, 50, 100 mg/kg). Treatments were administered either intraperitoneally (nitrosamine) or orally (pentoxifylline) on a daily basis for 28 days. The normalized kidney weight, glomeruli characteristics, thiobarbituric acid reactive species, antioxidant capacity, kidney function indicators, and serum nitrite oxide levels were investigated. Nitrosamine administration increased kidney malondialdehyde (MDA) level, kidney weight, blood urea nitrogen (BUN), creatinine, and nitrite oxide levels and decreased significantly glomeruli number and tissue ferric reducing/antioxidant power (FRAP) level compared to the control normal group (P < 0.05). The pentoxifylline and pentoxifylline + nitrosamine treatments reduced BUN, kidney MDA level, creatinine, glomerular diameter, and nitrite oxide levels significantly at all doses and increased the glomeruli number, kidney weight, and tissue FRAP level compared to the nitrosamine control group (P < 0.05). It seems that pentoxifylline administration improved kidney injury induced by nitrosamine in rats.
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Affiliation(s)
- Cyrus Jalili
- Medical Biology Research Center, Department of Anatomical Sciences, Medical School, Kermanshah University of Medical Sciences, Kermanshah, I.R. Iran
| | - Delnia Moradi
- Department of Anatomical Sciences, Medical School, Kermanshah University of Medical Sciences, Kermanshah, I.R. Iran
| | - Shiva Roshankhah
- Department of Anatomical Sciences, Medical School, Kermanshah University of Medical Sciences, Kermanshah, I.R. Iran
| | - Mohammad Reza Salahshoor
- Department of Anatomical Sciences, Medical School, Kermanshah University of Medical Sciences, Kermanshah, I.R. Iran
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11
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Siligato R, Cernaro V, Nardi C, De Gregorio F, Gembillo G, Costantino G, Conti G, Buemi M, Santoro D. Emerging therapeutic strategies for minimal change disease and focal and segmental glomerulosclerosis. Expert Opin Investig Drugs 2018; 27:839-879. [PMID: 30360670 DOI: 10.1080/13543784.2018.1540587] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/01/2023]
Abstract
INTRODUCTION Minimal change disease (MCD) and Focal and segmental glomerulosclerosis (FSGS) are two of the major causes of nephrotic syndrome (NS) in children and adults. According to KDIGO (Kidney Disease: Improving Global Outcomes) guidelines, the treatment of adult primary MCD and FSGS should be based on immunosuppressants and antiproteinuric drugs. Recently, Rituximab, a humanized monoclonal antibody (mAb) has emerged as a potential treatment for steroid or calcineurin inhibitor-dependent patients; it has however demonstrated lower efficacy in those with nephrotic syndrome that is resistant to the above indicated drugs. AREAS COVERED Analysis of ongoing and already completed clinical trials, retrieved from clinicaltrials.gov, clinicaltrialsregister.eu and PubMed involving new therapies for nephrotic syndrome secondary to MCD and FSGS. EXPERT OPINION The most promising drugs under investigation for MCD and FSGS are mAbs. We are hopeful that new therapeutic options to treat multi-drug resistant MCD and FSGS will emerge from currently ongoing studies. What appears certain is the difficulty in enrolling patients affected by orphan renal diseases and the selection of valid endpoints in clinical trials, such as kidney failure.
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Affiliation(s)
- Rossella Siligato
- a Unit of Nephrology and Dialysis, Department of Internal Medicine , Messina , Italy
| | - Valeria Cernaro
- a Unit of Nephrology and Dialysis, Department of Internal Medicine , Messina , Italy
| | - Chiara Nardi
- a Unit of Nephrology and Dialysis, Department of Internal Medicine , Messina , Italy
| | - Francesca De Gregorio
- a Unit of Nephrology and Dialysis, Department of Internal Medicine , Messina , Italy
| | - Guido Gembillo
- a Unit of Nephrology and Dialysis, Department of Internal Medicine , Messina , Italy
| | - Giuseppe Costantino
- a Unit of Nephrology and Dialysis, Department of Internal Medicine , Messina , Italy
| | - Giovanni Conti
- b Unit of Pediatric Nephrology and Rheumatology , University of Messina , Messina , Italy
| | - Michele Buemi
- a Unit of Nephrology and Dialysis, Department of Internal Medicine , Messina , Italy
| | - Domenico Santoro
- a Unit of Nephrology and Dialysis, Department of Internal Medicine , Messina , Italy
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12
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Protective effect of pentoxifylline on oxidative renal cell injury associated with renal crystal formation in a hyperoxaluric rat model. Urolithiasis 2018; 47:415-424. [PMID: 29980797 DOI: 10.1007/s00240-018-1072-8] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/03/2018] [Accepted: 06/25/2018] [Indexed: 12/25/2022]
Abstract
The aim of the study is to investigate the effects of pentoxifylline (PTX) on the renal tubular cell injury and stone formation in a hyperoxaluric rat model induced by ethylene glycol and its possible underlying mechanisms. The study was performed with 30 male Wistar rats and randomized into three groups of teen. The sham-control (group 1) received only drinking water orally. The EG/untreated (group 2) received drinking water containing 0.75% EG for 4 weeks orally. The EG/PTX treated (group 3) received drinking water containing 0.75% EG for 4 weeks orally and PTX. Urine and blood were collected to determine some parameters. The kidneys were also removed for histological examination. Serum and urinary parameters were significantly improved in the EG/PTX treated. In the EG/PTX-treated group, the MDA, TOS and MPO activity reduced and the TAS, SOD, CAT and GSH-Px activities were increased markedly compared with the group 2. In urine of the group 2 rats, a large number of CaOx crystals were displayed and most tubules that contained crystals were dilated and showed degeneration, necrosis, and desquamation of the lining epithelium. Only few CaOx crystals were r in EG/PTX-treated animal's urine. Mild tissue damage was observed in PTX-treated rats. iNOS expression was significantly elevated in the group 2. In contrast, in the EG/PTX-treated group, eNOS expression in renal tubular epithelial cells was increased. Current study indicates that PTX may partially reduce renal tubular injury resulting from hyperoxaluria-induced oxidative and nitrosative stress.
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13
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Chen YM, Chiang WC, Lin SL, Tsai TJ. Therapeutic efficacy of pentoxifylline on proteinuria and renal progression: an update. J Biomed Sci 2017; 24:84. [PMID: 29132351 PMCID: PMC5683556 DOI: 10.1186/s12929-017-0390-4] [Citation(s) in RCA: 17] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/25/2017] [Accepted: 10/30/2017] [Indexed: 01/17/2023] Open
Abstract
Blood pressure control with renin-angiotensin system (RAS) blockade has remained the gold standard for treating patients with proteinuric chronic kidney disease (CKD) up to date. Nevertheless, RAS blockade slows but does not halt the progression of kidney disease, thus highlighting the need to search for additional therapeutic approaches. The nonselective phosphodiesterase (PDE) inhibitor pentoxifylline (PTX) is an old drug that exhibits prominent anti-inflammatory, anti-proliferative and anti-fibrotic activities both in vitro and in vivo. Studies in human subjects have shown that PTX monotherapy decreases urinary protein excretion, and add-on therapy of PTX to background RAS blockade additively reduces proteinuria in patients with CKD of various etiology. More recent studies find that PTX combined with RAS blockade delays the decline of glomerular filtration rate in diabetic patients with mild to moderate CKD, and reduces the risk of end-stage renal disease in diabetic and non-diabetic patients in late stage of CKD with high proteinuria levels. In this review, we update the clinical trial results of PTX as monotherapy, or in conjunction or in comparison with RAS blockade on patients with proteinuria and CKD, and propose a mechanistic scheme explaining the renoprotective activities of this drug.
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Affiliation(s)
- Yung-Ming Chen
- Renal Division, Department of Medicine, National Taiwan University Hospital, College of Medicine, National Taiwan University, No. 7, Chung-Shan South Road, Taipei, Taiwan
| | - Wen-Chih Chiang
- Renal Division, Department of Medicine, National Taiwan University Hospital, College of Medicine, National Taiwan University, No. 7, Chung-Shan South Road, Taipei, Taiwan
| | - Shuei-Liong Lin
- Renal Division, Department of Medicine, National Taiwan University Hospital, College of Medicine, National Taiwan University, No. 7, Chung-Shan South Road, Taipei, Taiwan
- Graduate Institute of Physiology, College of Medicine, National Taiwan University, No. 1, Jen-Ai Road, Section 1, Taipei, Taiwan
| | - Tun-Jun Tsai
- Renal Division, Department of Medicine, National Taiwan University Hospital, College of Medicine, National Taiwan University, No. 7, Chung-Shan South Road, Taipei, Taiwan
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14
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Leporini C, Pisano A, Russo E, DArrigo G, de Sarro G, Coppolino G, Bolignano D. Effect of pentoxifylline on renal outcomes in chronic kidney disease patients: A systematic review and meta-analysis. Pharmacol Res 2016; 107:315-332. [DOI: 10.1016/j.phrs.2016.03.001] [Citation(s) in RCA: 24] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/22/2015] [Revised: 02/04/2016] [Accepted: 03/02/2016] [Indexed: 12/28/2022]
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15
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Cosarderelioglu C, Cosar AM, Gurakar M, Dagher NN, Gurakar A. Hepatopulmonary Syndrome and Liver Transplantation: A Recent Review of the Literature. J Clin Transl Hepatol 2016; 4:47-53. [PMID: 27047772 PMCID: PMC4807143 DOI: 10.14218/jcth.2015.00044] [Citation(s) in RCA: 24] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/24/2015] [Revised: 02/10/2016] [Accepted: 02/11/2016] [Indexed: 12/14/2022] Open
Abstract
A severe and common pulmonary vascular complication of liver disease is hepatopulmonary syndrome (HPS). It is a triad of liver dysfunction and/or portal hypertension, intrapulmonary vascular dilatations, and increased alveolar-arterial oxygen gradient. Prevalence varies according to various study groups from 4%-47%. While the most common presenting symptom of HPS is dyspnea, it is usually asymptomatic, and thus all liver transplant candidates should be screened for its presence. Pulse oximetry is a useful screening method, but arterial blood gas examination is the gold standard. If there is an abnormal P (A-a)O2 gradient, microbubble transthoracic echocardiography should be done for diagnosis. Outcome is unpredictable, and there is currently no effective medical therapy. The only effective therapy is considered to be liver transplantation. Complete resolution of HPS after liver transplantation is seen within a year in most HPS patients.
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Affiliation(s)
- Caglar Cosarderelioglu
- Johns Hopkins University School of Medicine, Department of Gastroenterology/Hepatology, Baltimore, MD, USA
| | - Arif M. Cosar
- Johns Hopkins University School of Medicine, Department of Gastroenterology/Hepatology, Baltimore, MD, USA
| | - Merve Gurakar
- Virginia Commonwealth University School of Medicine, Richmond, VA, USA
| | - Nabil N. Dagher
- Johns Hopkins University School of Medicine, Department of Surgery/Liver Transplant, Baltimore, MD, USA
| | - Ahmet Gurakar
- Johns Hopkins University School of Medicine, Department of Gastroenterology/Hepatology, Baltimore, MD, USA
- Correspondence to: Ahmet Gurakar, 720 Rutland Avenue, Ross Research Building, Suite #918, Baltimore, Maryland, 21205, USA, Tel: 410-614-3369, Fax: 410-367-2328, E-mail:
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16
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Abstract
Nephrotic Syndrome is a rare condition associated with high morbidity in the 20-40% of children and adolescents who fail to respond to standard immunosuppressive therapies. Novel non-immunologic mechanisms of widely used immunosuppressive therapies, as well as emerging anti-inflammatory drugs, and anti-fibrotics may play a crucial role in the treatment of patients with refractory disease. This article will review some of these treatments and their various stages of investigation.
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Affiliation(s)
- Keisha L Gibson
- University of North Carolina Kidney Center at Chapel Hill, 7005 Burnett Womack, Chapel Hill, NC, 27599-7155, USA.
| | | | - Maria E Ferris
- University of North Carolina Kidney Center at Chapel Hill, 7005 Burnett Womack, Chapel Hill, NC, 27599-7155, USA
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17
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Kuo KL, Hung SC, Liu JS, Chang YK, Hsu CC, Tarng DC. Add-on Protective Effect of Pentoxifylline in Advanced Chronic Kidney Disease Treated with Renin-Angiotensin-Aldosterone System Blockade - A Nationwide Database Analysis. Sci Rep 2015; 5:17150. [PMID: 26612282 PMCID: PMC4661470 DOI: 10.1038/srep17150] [Citation(s) in RCA: 15] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/07/2015] [Accepted: 10/26/2015] [Indexed: 02/07/2023] Open
Abstract
A combination therapy of pentoxifylline with an angiotensin converting enzyme inhibitor (ACEI) or an angiotensin II receptor blocker (ARB) decreased proteinuria or glomerular filtration rate decline in early chronic kidney disease (CKD). Whether adding pentoxifylline to ACEI/ARB provides additional benefits on outcome is unclear in CKD stage 5 patients who have not yet received dialysis (CKD 5 ND). A prospective cohort study was conducted based on the Taiwan National Health Insurance Research Database. From January 1, 2000 to June 30, 2009, we enrolled 14,117 CKD 5 ND with serum creatinine levels >6 mg/dL and hematocrit levels <28% and who have been treated with ACEI/ARB. All patients were divided into pentoxifylline users and nonusers. Patient follow-up took place until dialysis, death before initiation of dialysis or December 31, 2009. Finally, 9,867 patients (69.9%) required long-term dialysis and 2,805 (19.9%) died before dialysis. After propensity score-matching, use of pentoxifylline was associated with a lower risk for long-term dialysis or death in ACEI/ARB users (HR, 0.94; 95% CI, 0.90–0.99) or ARB users (HR, 0.91; 95% CI, 0.85–0.97). In conclusion, pentoxifylline exhibited a protective effect in reducing the risk for the composite outcome of long-term dialysis or death in ACEI/ARB treated CKD 5 ND.
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Affiliation(s)
- Ko-Lin Kuo
- Division of Nephrology, Taipei Tzu Chi Hospital, Buddhist Tzu Chi Medical Foundation, Taiwan.,School of Medicine, Tzu Chi University, Hualien, Taiwan
| | - Szu-Chun Hung
- Division of Nephrology, Taipei Tzu Chi Hospital, Buddhist Tzu Chi Medical Foundation, Taiwan.,School of Medicine, Tzu Chi University, Hualien, Taiwan
| | - Jia-Sin Liu
- Institute of Population Health Sciences, National Health Research Institutes, Taiwan
| | - Yu-Kang Chang
- Institute of Population Health Sciences, National Health Research Institutes, Taiwan
| | - Chih-Cheng Hsu
- Institute of Population Health Sciences, National Health Research Institutes, Taiwan.,Department of Health Services Administration, China Medical University, Taichung, Taiwan.,Institute of Clinical Medicine, National Yang-Ming University, Taipei, Taiwan
| | - Der-Cherng Tarng
- Institute of Clinical Medicine, National Yang-Ming University, Taipei, Taiwan.,Department and Institute of Physiology, National Yang-Ming University, Taipei, Taiwan.,Division of Nephrology, Department of Medicine, Taipei Veterans General Hospital, Taiwan
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18
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Jiang X, Zhou S, Yao J, Kong X, Cui M. Effect of pentoxifylline in proteinuric chronic kidney disease: a systematic review and meta-analysis. J Nephrol 2015; 29:653-62. [PMID: 26510426 DOI: 10.1007/s40620-015-0240-y] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/22/2015] [Accepted: 10/16/2015] [Indexed: 01/14/2023]
Abstract
AIM The aim of this study was to assess the effect of pentoxifylline on proteinuria and renal function in chronic kidney disease (CKD) treatment. METHODS We systematically searched PubMed, EMBASE, the Cochrane Library and ClinicalTrials.gov for randomized and non-randomized controlled trials comparing pentoxifylline to placebo, no treatment or renin-angiotensin system blockade in proteinuric CKD patients. The outcomes concerning proteinuria, renal function, blood pressure and adverse events were extracted. RESULTS Twelve trials with 613 participants were identified. Pentoxifylline significantly decreased proteinuria [weighted mean difference (WMD) -0.60 g/day (95 % CI -0.84 to -0.36); p < 0.001] compared to placebo or no-treatment groups, but the decrease was not significant [WMD: 0.10 g/day (-0.34 to 0.54); p = 0.66] compared to captopril treatment. The decrease of glomerular filtration rate was significantly less [WMD: 3.67 ml/min (2.71-4.62); p < 0.001] in the pentoxifylline group than in the controls. There was no significant difference in serum creatinine [WMD: -0.03 mg/dl (-0.10 to 0.03); p = 0.28], diastolic blood pressure [WMD: 0.94 mmHg (-0.74 to 2.61); p = 0.27] and adverse events [RR: 0.89 (0.60 to 1.32); p = 0.56]. CONCLUSIONS Pentoxifylline may decrease proteinuria and protect renal function in patients with CKD. Further studies are needed to confirm this result.
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Affiliation(s)
- Xiangpin Jiang
- Department of Nephrology, Jining No. 1 People's Hospital, Jining, People's Republic of China
| | - Shengguo Zhou
- Department of Nephrology, Jining No. 1 People's Hospital, Jining, People's Republic of China
| | - Jing Yao
- The Blood Purification Center, Shandong Veterans General Hospital, Jinan, People's Republic of China
| | - Xianglei Kong
- Department of Nephrology, Qianfoshan Hospital, Shandong University, No. 16766, Jingshi Road, Jinan, 250014, People's Republic of China
| | - Meiyu Cui
- Department of Nephrology, Qianfoshan Hospital, Shandong University, No. 16766, Jingshi Road, Jinan, 250014, People's Republic of China.
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19
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Wu PC, Wu CJ, Lin CJ, Pan CF, Chen CY, Huang TM, Wu CH, Lin SL, Chen YM, Chen L, Wu VC. Pentoxifylline Decreases Dialysis Risk in Patients With Advanced Chronic Kidney Disease. Clin Pharmacol Ther 2015; 98:442-9. [PMID: 26082272 DOI: 10.1002/cpt.173] [Citation(s) in RCA: 21] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/17/2015] [Accepted: 06/11/2015] [Indexed: 11/08/2022]
Abstract
Few studies evaluated the effects of pentoxifylline on hard endpoints in patients with predialysis stage 5 chronic kidney disease (CKD). Thus, we tried to explore the effects of pentoxifylline and its interaction with renin-angiotensin-aldosterone system (RAAS) blockade on the development of endstage renal disease (ESRD) and mortality. This nationwide cohort study retrospectively included patients who had a serum creatinine level of >6 mg/dL and received erythropoiesis-stimulating agents (ESAs) between 2000 and 2010. We analyzed 7,366 pentoxifylline users and 7,366 propensity score-matched nonusers. Using Cox proportional hazard models, pentoxifylline reduced the risks of ESRD and the composite renal outcome but not that of mortality. In terms of the risks of developing ESRD, pentoxifylline alone exerted a comparable beneficial effect to combined therapy with an RAAS inhibitor and greater renoprotection than RAAS inhibitor monotherapy. This study suggests pentoxifylline is efficacious in slowing progression to ESRD in patients with predialysis stage 5 CKD.
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Affiliation(s)
- P-C Wu
- Division of Nephrology, Department of Internal Medicine, Mackay Memorial Hospital, Taipei, Taiwan.,Graduate Institute of Clinical Medicine, College of Medicine, National Taiwan University, Taipei, Taiwan
| | - C-J Wu
- Division of Nephrology, Department of Internal Medicine, Mackay Memorial Hospital, Taipei, Taiwan.,Department of Medicine, Mackay Medical College, Taipei, Taiwan.,Graduate Institute of Medical Sciences and Department of Pharmacology, College of Medicine, Taipei Medical University, Taipei, Taiwan
| | - C-J Lin
- Division of Nephrology, Department of Internal Medicine, Mackay Memorial Hospital, Taipei, Taiwan.,Department of Medicine, Mackay Medical College, Taipei, Taiwan.,Mackay Junior College of Medicine, Nursing and Management, Taipei, Taiwan
| | - C-F Pan
- Division of Nephrology, Department of Internal Medicine, Mackay Memorial Hospital, Taipei, Taiwan
| | - C-Y Chen
- Division of Nephrology, Department of Internal Medicine, Mackay Memorial Hospital, Taipei, Taiwan
| | - T-M Huang
- Department of Internal Medicine, National Taiwan University Hospital Yun-Lin Branch, Douliou City, Yunlin County, Taiwan
| | - C-H Wu
- Division of Nephrology, Taipei Buddhist Tzu Chi General Hospital, Buddhist Tzu Chi University, Taipei, Taiwan
| | - S-L Lin
- Division of Nephrology, Department of Internal Medicine, National Taiwan University Hospital, Taipei, Taiwan
| | - Y-M Chen
- Division of Nephrology, Department of Internal Medicine, National Taiwan University Hospital, Taipei, Taiwan
| | - L Chen
- Institute of Population Health Sciences, National Health Research Institutes, Zhunan, Taiwan
| | - V-C Wu
- Division of Nephrology, Department of Internal Medicine, National Taiwan University Hospital, Taipei, Taiwan
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20
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Azimi A, Ziaee SM, Farhadi P, Sagheb MM. Hypothesis: Pentoxifylline explores new horizons in treatment of preeclampsia. Med Hypotheses 2015; 85:468-74. [PMID: 26164832 DOI: 10.1016/j.mehy.2015.06.031] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/29/2015] [Revised: 06/12/2015] [Accepted: 06/28/2015] [Indexed: 12/19/2022]
Abstract
Preeclampsia, the leading cause of maternal morbidity and perinatal mortality, initiates as inappropriate immune response to trophoblastic invasion impairs placentation and placental circulation. A poorly perfused placenta generates superoxide anions as well as anti-angiogenic factors and this series of events result in impairment of endothelial function, followed by maternal morbidities such as hypertension, kidney injury and proteinuria. Renal loss of anti-coagulant proteins and subsequent hyper-coagulable state along with endothelial dysfunction accelerates progression of the disease toward eclampsia. Since Pentoxifylline, a methyl-xanthine derivative known for enhancement of vascular endothelial function, down-regulation of many inflammatory cytokines increased during preeclampsia, improvement of placental circulation, reduction of ischemia-reperfusion injury, enhancement of vasodilatation and endothelial function, ameliorating proteinuria, inhibition of platelet aggregation and decreasing risk of preterm labor, which are all amongst morbidities of preeclampsia, here it is hypothesized that Pentoxifylline prevents development of preeclampsia and/or decelerate progression of the disease.
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Affiliation(s)
- Arsalan Azimi
- Faculty of Medicine, Shiraz University of Medical Sciences, Shiraz, Iran.
| | | | - Pouya Farhadi
- Faculty of Medicine, Shiraz University of Medical Sciences, Shiraz, Iran
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21
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Chen YM, Chiang WC, Yang Y, Lai CF, Wu KD, Lin SL. Pentoxifylline Attenuates Proteinuria in Anti-Thy1 Glomerulonephritis via Downregulation of Nuclear Factor-κB and Smad2/3 Signaling. Mol Med 2015; 21:276-84. [PMID: 25879629 DOI: 10.2119/molmed.2015.00023] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/26/2015] [Accepted: 04/13/2015] [Indexed: 12/13/2022] Open
Abstract
Anti-Thy1 glomerulonephritis is a rat nephritis model closely simulating human mesangial proliferative glomerulonephritis. It affects primarily the mesangium, yet displays substantial proteinuria during the course. This study investigated the molecular signals underlying proteinuria in this disease and the modulation of which by the known antiproteinuric agent, pentoxifylline. Male Wistar rats were randomly divided into a control group and nephritic groups with or without treatment with IMD-0354 (an IκB kinase inhibitor), SB431542 (an activin receptor-like kinase inhibitor) or pentoxifylline. Kidney sections were prepared for histological examinations. Glomeruli were isolated for mRNA and protein analysis. Urine samples were collected for protein and nephrin quantitation. One day after nephritis induction, proteinuria developed together with ultrastructural changes of the podocyte and downregulation of podocyte mRNA and protein expression. These were associated with upregulation of tumor necrosis factor (TNF)-α and transforming growth factor (TGF)-β/activins mRNAs and activation of nuclear factor (NF)-κB p65 and Smad2/3. IMD-0354 attenuated proteinuria on d 1, whereas SB431542 decreased proteinuria on d 3 and 5, in association with partial restoration of downregulated podocyte mRNA and protein expression. Pentoxifylline attenuated proteinuria and nephrinuria through the course, plus inhibition of p-NF-κB p65 (d 1) and p-Smad2/3 (d 5) and partial reversal of downregulated podocyte mRNA and protein. Our data show that the pathogenesis of proteinuria in anti-Thy1 glomerulonephritis involves TNF-α and TGF-β/activin pathways, and the evolution of this process can be attenuated by pentoxifylline via downregulation of NF-κB and Smad signals and restoration of the podocyte component of the glomerular filtration barrier.
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Affiliation(s)
- Yung-Ming Chen
- Renal Division, Department of Internal Medicine, National Taiwan University Hospital, College of Medicine, National Taiwan University, Taipei, Taiwan.,Renal Division, Department of Internal Medicine, National Taiwan University Hospital, Yun-Lin Branch, Yun-Lin, Taiwan
| | - Wen-Chih Chiang
- Renal Division, Department of Internal Medicine, National Taiwan University Hospital, College of Medicine, National Taiwan University, Taipei, Taiwan
| | - Yalin Yang
- Renal Division, Department of Internal Medicine, National Taiwan University Hospital, College of Medicine, National Taiwan University, Taipei, Taiwan
| | - Chun-Fu Lai
- Renal Division, Department of Internal Medicine, National Taiwan University Hospital, College of Medicine, National Taiwan University, Taipei, Taiwan
| | - Kwan-Dun Wu
- Renal Division, Department of Internal Medicine, National Taiwan University Hospital, College of Medicine, National Taiwan University, Taipei, Taiwan
| | - Shuei-Liong Lin
- Renal Division, Department of Internal Medicine, National Taiwan University Hospital, College of Medicine, National Taiwan University, Taipei, Taiwan
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22
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Efficacy and safety of combining pentoxifylline with angiotensin-converting enzyme inhibitor or angiotensin II receptor blocker in diabetic nephropathy: a meta-analysis. Int Urol Nephrol 2015; 47:815-22. [PMID: 25862237 DOI: 10.1007/s11255-015-0968-2] [Citation(s) in RCA: 18] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/26/2015] [Accepted: 03/29/2015] [Indexed: 01/08/2023]
Abstract
OBJECTIVE Pentoxifylline (PTF) has anti-inflammatory properties, which may be beneficial for diabetic nephropathy (DN). A meta-analysis was conducted to assess the additive effect of pentoxifylline and its safety among patients with type 2 DN under blockade of angiotensin system. DATA SOURCES Relevant studies were searched from PubMed, CBM, EMBASE, CENTRAL and Cochrane renal group specialized register. SELECTION CRITERIA All RCTs that compared the benefits and harms of pentoxifylline and ACEI/ARB with ACEI/ARB alone for DN were included. DATA EXTRACTION AND ANALYSIS Pertinent data were extracted independently by two authors. Meta-analyses were performed when more than one study provided data on a comparable outcome. Standard mean differences (SMDs) for proteinuria and albuminuria, mean differences (MDs) for systolic blood pressure (SBP), diastolic blood pressure (DBP), HbA1c, serum creatinine (Scr), creatinine clearance (CrCl) and urine tumor necrosis factor-alpha (UTNF-α), 95% confidence intervals (CIs) were calculated, and heterogeneity was assessed with the I (2) test. Adverse effects were assessed using descriptive techniques. RESULTS Eight studies including 587 patients with a median duration of 5 months were identified. Compared with ACEI/ARB alone, the combination of PTF and ACEI/ARB significantly reduced proteinuria (SMD 0.76, 95% CI 0.52-0.99), albuminuria (SMD 0.36, 95% CI 0.12-0.59) and UTNF-α (MD 1.56 ng/g, 95% CI 0.09-3.03). However, no statistically significant changes were observed for SBP, DBP, HbA1c, Scr and CrCl. The most frequent adverse effects in patients treated with PTF were gastrointestinal symptoms (28/298) and dizziness (7/298), but in most cases, these symptoms were mild, only six participants withdrew due to intractable nausea and vomiting. CONCLUSIONS Pentoxifylline can significantly provide additive antiproteinuric effect independent from the decrease in BP or improvement in glycemic control in DN patients under blockade of angiotensin system. Further large, multicenter, high-quality studies with long duration are necessary to prove whether it really has renoprotective effects in this patient population.
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Shahidi S, Hoseinbalam M, Iraj B, Akbari M. Effect of pentoxifylline on microalbuminuria in diabetic patients: a randomized controlled trial. Int J Nephrol 2015; 2015:259592. [PMID: 25874129 PMCID: PMC4385644 DOI: 10.1155/2015/259592] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/23/2014] [Revised: 01/22/2015] [Accepted: 02/08/2015] [Indexed: 01/08/2023] Open
Abstract
Background. Pentoxifylline is a nonspecific phosphodiesterase inhibitor with anti-inflammatory properties. Human studies have proved its antiproteinuric effect in patients with glomerular diseases, but this study was designed to assess the effects of add-on pentoxifylline to available treatment on reduction of microalbuminuria in diabetic patients without glomerular diseases. Methods. In a double-blind placebo-controlled, randomized study we evaluated the influence of pentoxifylline on microalbuminuria in type 2 diabetic patients. 40 diabetic patients with estimated glomerular filtration rate (eGFR) of more than 60 mL/min/1.73 m(2) in eight weeks and microalbuminuria were randomized to two groups which will receive pentoxifylline 1200 mg/day or placebo added to regular medications for 6 months. albuminuria; eGFR was evaluated at three- and six-month follow-up period. Results. Baseline characteristics were similar between the two groups. At six months, the mean estimated GFR and albuminuria were not different between two groups at 3- and 6-month follow-up. Trend of albumin to creatinine ratio, systolic and diastolic blood pressure, and eGFR in both groups were decreased, but no significant differences were noted between two groups (P value > 0.05). Conclusion. Pentoxifylline has not a significant additive antimicroalbuminuric effect compared with placebo in patients with type 2 diabetes with early stage of kidney disease; however, further clinical investigations are necessary to be done.
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Affiliation(s)
- Shahrzad Shahidi
- Isfahan Kidney Disease Research Center, Isfahan University of Medical Sciences, Isfahan, Iran
| | - Marziyeh Hoseinbalam
- Isfahan Endocrine and Metabolism Research Center, Isfahan University of Medical Sciences, Isfahan, Iran
| | - Bijan Iraj
- Isfahan Endocrine and Metabolism Research Center, Isfahan University of Medical Sciences, Isfahan, Iran
| | - Mojtaba Akbari
- Department of Epidemiology, School of Health and Nutrition, Shiraz University of Medical Sciences, Shiraz, Iran
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Lai WL, Yeh TH, Chen PM, Chan CK, Chiang WC, Chen YM, Wu KD, Tsai TJ. Membranous nephropathy: a review on the pathogenesis, diagnosis, and treatment. J Formos Med Assoc 2015; 114:102-11. [PMID: 25558821 DOI: 10.1016/j.jfma.2014.11.002] [Citation(s) in RCA: 77] [Impact Index Per Article: 8.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/10/2014] [Revised: 11/07/2014] [Accepted: 11/12/2014] [Indexed: 11/25/2022] Open
Abstract
In adults, membranous nephropathy (MN) is a major cause of nephrotic syndrome. However, the etiology of approximately 75% of MN cases is idiopathic. Secondary causes of MN are autoimmune diseases, infection, drugs, and malignancy. The pathogenesis of MN involves formation of immune complex in subepithelial sites, but the definite mechanism is still unknown. There are three hypotheses about the formation of immune complex, including preformed immune complex, in situ immune-complex formation, and autoantibody against podocyte membrane antigen. The formation of immune complex initiates complement activation, which subsequently leads to glomerular damage. Recently, the antiphospholipase A2 receptor antibody was found to be associated with idiopathic MN. This finding may be useful in the diagnosis and prognosis of MN. The current treatment includes best supportive care, which consists of the use of angiotensin-converting enzyme inhibitors/angiotensin II receptor blockers, lipid-lowering agents, and optimal control of blood pressure. Immunosuppressive agents should be used for patients who suffer from refractory proteinuria or complications associated with nephrotic syndrome. Existing evidence supports the use of a combination of steroid and alkylating agents. This article reviews the epidemiology, pathogenesis, diagnosis, and the treatment of MN.
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Affiliation(s)
- Wei Ling Lai
- Department of Internal Medicine, National Taiwan University Hospital, Taipei, Taiwan
| | - Ting Hao Yeh
- Department of Internal Medicine, National Taiwan University Hospital, Taipei, Taiwan
| | - Ping Min Chen
- Department of Internal Medicine, National Taiwan University Hospital, Taipei, Taiwan
| | - Chieh Kai Chan
- Department of Internal Medicine, National Taiwan University Hospital, Taipei, Taiwan
| | - Wen Chih Chiang
- Department of Internal Medicine, National Taiwan University Hospital, Taipei, Taiwan.
| | - Yung Ming Chen
- Department of Internal Medicine, National Taiwan University Hospital, Taipei, Taiwan
| | - Kwan Dun Wu
- Department of Internal Medicine, National Taiwan University Hospital, Taipei, Taiwan
| | - Tun Jun Tsai
- Department of Internal Medicine, National Taiwan University Hospital, Taipei, Taiwan
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Roy-Chaudhury P. Emerging Therapies for Chronic Kidney Disease. CHRONIC RENAL DISEASE 2015:771-780. [DOI: 10.1016/b978-0-12-411602-3.00064-0] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 07/19/2023]
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Han SJ, Kim HJ, Kim DJ, Sheen SS, Chung CH, Ahn CW, Kim SH, Cho YW, Park SW, Kim SK, Kim CS, Kim KW, Lee KW. Effects of pentoxifylline on proteinuria and glucose control in patients with type 2 diabetes: a prospective randomized double-blind multicenter study. Diabetol Metab Syndr 2015; 7:64. [PMID: 26300986 PMCID: PMC4546105 DOI: 10.1186/s13098-015-0060-1] [Citation(s) in RCA: 20] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/24/2015] [Accepted: 07/09/2015] [Indexed: 12/12/2022] Open
Abstract
BACKGROUND Pentoxifylline is a methylxanthine derivative with significant anti-inflammatory, anti-fibrotic, and anti-proliferative properties. Studies have shown that pentoxifylline may have renoprotective effects in patients with diabetic nephropathy. However, most of these studies were limited by small sample sizes. Therefore, we investigated whether pentoxifylline could reduce proteinuria in patients with diabetic nephropathy and residual proteinuria who received an angiotensin-converting enzyme inhibitor (ACEI) or an angiotensin II receptor blocker (ARB). We also studied the effects of pentoxifylline on glycemic control, insulin resistance, and inflammatory parameters. METHODS This was a prospective, randomized double-blind, placebo-controlled, multi-center study. A total of 174 patients with type 2 diabetes and albuminuria (>30 mg/g of creatinine) who were taking the recommended dosage of ACEI or ARB for > 6 months and receiving conventional therapy for diabetes were randomly assigned to receive pentoxifylline (1200 mg, daily; n = 87) or a placebo (n = 87) for 6 months. The endpoints were the effects of pentoxifylline on proteinuria, renal function, glucose control, and inflammatory parameters. RESULTS The percentage changes in proteinuria from baseline in the pentoxifylline and placebo groups were a decrease of 23 % and 4 %, respectively (p = 0.012). In addition, significant reductions in fasting plasma glucose, glycated hemoglobin, and insulin resistance according to the homeostasis model assessment were observed in the pentoxifylline group compared to those in the placebo group. However there was no significant difference in serum tumor necrosis factor (TNF)-α between the groups. CONCLUSIONS Pentoxifylline therapy reduced proteinuria and improved glucose control and insulin resistance without significant change of serum TNF-α in patients with type 2 diabetic nephropathy. Therefore, pentoxifylline is a potential therapeutic alternative for treating diabetes and diabetic nephropathy. TRIAL REGISTRATION NCT01382303.
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Affiliation(s)
- Seung Jin Han
- />Department of Endocrinology and Metabolism, Ajou University School of Medicine, 164, World Cup-ro, Yeongtong-gu, Suwon, 443-380 Korea
| | - Hae Jin Kim
- />Department of Endocrinology and Metabolism, Ajou University School of Medicine, 164, World Cup-ro, Yeongtong-gu, Suwon, 443-380 Korea
| | - Dae Jung Kim
- />Department of Endocrinology and Metabolism, Ajou University School of Medicine, 164, World Cup-ro, Yeongtong-gu, Suwon, 443-380 Korea
| | - Seung Soo Sheen
- />Section of Clinical Epidemiology and Biostatistics in Clinical Trial Center, Ajou University School of Medicine, Suwon, 443-380 Korea
| | - Choon Hee Chung
- />Department of Internal Medicine, Yonsei University Wonju College of Medicine, Wonju, 220-701 Korea
| | - Chul Woo Ahn
- />Department of Internal Medicine, Gangnam Severance Hospital, Yonsei University College of Medicine, Seoul, 135-720 Korea
| | - Se Hwa Kim
- />Division of Endocrinology, Department of Internal Medicine, Catholic Kwandong University College of Medicine, Incheon, 404-834 Korea
| | - Yong-Wook Cho
- />Department of Internal Medicine, CHA Bundang Medical Center, CHA University, Seongnam, 463-712 Korea
| | - Seok Won Park
- />Department of Internal Medicine, CHA Bundang Medical Center, CHA University, Seongnam, 463-712 Korea
| | - Soo-Kyung Kim
- />Department of Internal Medicine, CHA Bundang Medical Center, CHA University, Seongnam, 463-712 Korea
| | - Chul Sik Kim
- />Division of Endocrinology and Metabolism, Department of Internal Medicine, Hallym University Sacred Heart Hospital, Hallym University College of Medicine, Anyang, 431-796 Korea
| | - Kyung Wook Kim
- />Dongtan jeil Women’s Hospital, Hwaseong, 445-170 Korea
- />Severance Institute for Vascular and Metabolic Research, Yonesei University College of Medicine, Seoul, 120-752 Korea
| | - Kwan Woo Lee
- />Department of Endocrinology and Metabolism, Ajou University School of Medicine, 164, World Cup-ro, Yeongtong-gu, Suwon, 443-380 Korea
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Noone D, Licht C. Chronic kidney disease: a new look at pathogenetic mechanisms and treatment options. Pediatr Nephrol 2014; 29:779-92. [PMID: 23471475 DOI: 10.1007/s00467-013-2436-5] [Citation(s) in RCA: 31] [Impact Index Per Article: 3.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/28/2013] [Revised: 01/31/2013] [Accepted: 02/06/2013] [Indexed: 12/16/2022]
Abstract
The concept of renoprotection has evolved significantly, driven by improved understanding of the pathophysiology of chronic kidney disease (CKD) and the advent of novel treatment options. Glomerular hyperfiltration, hypertension and proteinuria represent key mediators of CKD progression. It is increasingly recognized that proteinuria may actually be pathological and etiological in CKD progression and not just symptomatic. It initiates a sequence of events involving activation of proinflammatory and profibrotic signaling pathways in proximal tubular epithelial cells with transmission of the disease to the tubulointerstitium and progression to end-stage kidney disease (ESKD). Although the etiology and epidemiology of pediatric CKD differs to that in adults, studies in the various animal models of kidney disease, from obstructive uropathy to glomerulonephritis, have revealed that many common proinflammatory and profibrotic pathways are induced in progressive proteinuric CKD, irrespective of the primary disease. This pathomechanistic overlap therefore translates into the potential for common treatment targets for a wide spectrum of kidney diseases. In this review we therefore discuss the experimental and clinical evidence for an array of prospective future drug treatments of CKD progression. While conceptually promising, clear definitive evidence beyond preclinical data does not exist for many of these treatments, and others are limited by serious adverse effects. More studies are needed before general recommendations can be given.
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Affiliation(s)
- Damien Noone
- Division of Nephrology, Department of Paediatrics, The Hospital for Sick Children, 555 University Avenue, Toronto, M5G 1X8, ON, Canada
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Tang WH, Lin FH, Lee CH, Kuo FC, Hsieh CH, Hsiao FC, Hung YJ. Cilostazol effectively attenuates deterioration of albuminuria in patients with type 2 diabetes: a randomized, placebo-controlled trial. Endocrine 2014; 45:293-301. [PMID: 23775007 DOI: 10.1007/s12020-013-0002-3] [Citation(s) in RCA: 25] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/24/2013] [Accepted: 06/08/2013] [Indexed: 01/25/2023]
Abstract
Cilostazol is an antiplatelet, antithrombotic agent with anti-inflammatory properties. To date, no clinical study has specifically evaluated the efficacy of cilostazol in patients with diabetic nephropathy (DN). We hypothesized that cilostazol might delay renal deterioration in DN patients at high risk of progression. Between April 2008 and April 2010, we screened 156 consecutive patients aged 35-80 years who were first diagnosed with type 2 diabetes after the age of 30 years. Of these, 90 patients with DN, as defined by morning spot urine microalbuminuria (MAU) >20 mg/L or an albumin-to-creatinine ratio (ACR) >30 μg/mg on at least two consecutive occasions within the prior 3 months, were enrolled into a 52-week randomized, single-blinded, placebo-controlled trial of oral cilostazol 100 mg twice daily or placebo (45 subjects in each group). Morning spot urine samples were collected to determine MAU and ACR. Fasting plasma levels of metabolic, endothelial variables, and inflammatory markers were examined. Following 52 weeks of treatment, urinary MAU and ACR were significantly reduced in the cilostazol group compared with the placebo group (P = 0.024 and P = 0.02, respectively). In regression analyses, changes in monocyte chemotactic protein-1, E-selectin, and soluble vascular cell adhesion molecule-1 (sVCAM-1) were significantly associated with changes in MAU and ACR. Net changes of E-selectin (P < 0.001) and sVCAM-1 (P < 0.05) were independent predictors of change in MAU and ACR, respectively. Our results suggest that cilostazol may effectively attenuate deterioration of albuminuria in patients with type 2 diabetes. This effect is likely mediated by an improvement of adhesion molecules.
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Affiliation(s)
- Wen-Hao Tang
- Division of Endocrinology and Metabolism, Department of Internal Medicine, Tri-Service General Hospital, National Defense Medical Center, No. 325, Sec. 2, Chen-Kung Rd., Nei-Hu, Taipei, Taiwan
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Chen PM, Lai TS, Chen PY, Lai CF, Wu V, Chiang WC, Chen YM, Wu KD, Tsai TJ. Renoprotective effect of combining pentoxifylline with angiotensin-converting enzyme inhibitor or angiotensin II receptor blocker in advanced chronic kidney disease. J Formos Med Assoc 2014; 113:219-26. [PMID: 24512756 DOI: 10.1016/j.jfma.2014.01.002] [Citation(s) in RCA: 24] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/23/2013] [Revised: 12/19/2013] [Accepted: 01/08/2014] [Indexed: 11/26/2022] Open
Abstract
BACKGROUND/PURPOSE Several studies have shown the renoprotective effects of pentoxifylline in the treatment of chronic kidney disease (CKD). This study was conducted to examine whether there was an increased benefit of including pentoxifylline with angiotensin-converting enzyme inhibitor (ACEI) or angiotensin II receptor blocker (ARB) in the treatment of CKD. METHODS A single-center retrospective analysis was conducted. A total of 661 Stage 3B-5 CKD patients who received ACEI or ARB treatment were recruited. The patients were divided into the pentoxifylline use group and the no pentoxifylline group. Renal survival analysis of the two groups was compared. Subgroup analysis was performed by dividing the patients into lower [urine protein to creatinine ratio (UPCR)<1 g/g] and higher (UPCR ≥ 1 g/g) proteinuria subgroups. RESULTS There was no between-groups difference regarding mortality and cardiovascular events. Addition of pentoxifylline showed a better renal outcome (p = 0.03). The protective effect of add-on pentoxifylline was demonstrated in the higher proteinuria subgroup (p = 0.005). In the multivariate Cox regression model, pentoxifylline use also showed a better renal outcome [hazard ratio (HR): 0.705; 95% confidence interval (CI): 0.498-0.997; p = 0.048]. This effect was more prominent in the higher proteinuria subgroup (HR: 0.602; 95% CI: 0.413-0.877; p = 0.008). CONCLUSION In the advanced stages of CKD, patients treated with a combination of pentoxifylline and ACEI or ARB had a better renal outcome than those treated with ACEI or ARB alone. This effect was more prominent in the higher proteinuria subgroup. More large randomized control trials are needed to provide concrete evidence of the add-on effect of pentoxifylline.
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Affiliation(s)
- Ping-Min Chen
- Department of Internal Medicine, National Taiwan University Hospital, Taipei, Taiwan
| | - Tai-Shuan Lai
- Department of Internal Medicine, National Taiwan University Hospital, Bei-Hu Branch, Taipei, Taiwan
| | - Ping-Yu Chen
- Department of Internal Medicine, National Taiwan University Hospital, Taipei, Taiwan; Department of Internal Medicine, Chi Mei Medical Center, Chiali Campus, Tainan, Taiwan
| | - Chun-Fu Lai
- Department of Internal Medicine, National Taiwan University Hospital, Taipei, Taiwan
| | - Vincent Wu
- Department of Internal Medicine, National Taiwan University Hospital, Taipei, Taiwan
| | - Wen-Chih Chiang
- Department of Internal Medicine, National Taiwan University Hospital, Taipei, Taiwan.
| | - Yung-Ming Chen
- Department of Internal Medicine, National Taiwan University Hospital, Taipei, Taiwan
| | - Kwan-Dun Wu
- Department of Internal Medicine, National Taiwan University Hospital, Taipei, Taiwan
| | - Tun-Jun Tsai
- Department of Internal Medicine, National Taiwan University Hospital, Taipei, Taiwan
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Pharmacological treatment for hepatopulmonary syndrome. BIOMED RESEARCH INTERNATIONAL 2013; 2013:670139. [PMID: 24102057 PMCID: PMC3786536 DOI: 10.1155/2013/670139] [Citation(s) in RCA: 17] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 04/25/2013] [Revised: 07/30/2013] [Accepted: 08/12/2013] [Indexed: 12/12/2022]
Abstract
AIM Hepatopulmonary syndrome is a pulmonary dysfunction in the context of liver cirrhosis characterized by arterial deoxygenation. Affected patients have increased morbidity and mortality, and many of them expire before undergoing liver transplantation. Therefore, finding medical therapy as a bridge to transplantation or as a final treatment is necessary. In this study, we aimed to review the current literature about pharmacological options available for treatment of hepatopulmonary syndrome. METHODS A PubMED and Scopus search was conducted in January 2013 on the English literature published in any time period to find human and animal studies reporting pharmacological therapy of hepatopulmonary syndrome. RESULTS Out of 451 studies, 29 relevant articles were included. The number of patients, type, dose, duration, and mechanism of drugs in these studies was extracted and summarized separately. Most of pharmacologic agents act through inhibition of nitric oxide synthase and reduction in nitric oxide production, inactivation of endothelin-1, and treatment of bacterial translocation and pulmonary angiogenesis. CONCLUSION Several drugs have been applied for the treatment of HPS with conflicting results. However, no large randomized trial has been conducted probably due to low number of patients. Multicentered clinical trials are necessary to investigate these drugs.
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Badri S, Dashti-Khavidaki S, Ahmadi F, Mahdavi-Mazdeh M, Abbasi MR, Khalili H. Effect of add-on pentoxifylline on proteinuria in membranous glomerulonephritis: a 6-month placebo-controlled trial. Clin Drug Investig 2013; 33:215-22. [PMID: 23392759 DOI: 10.1007/s40261-013-0057-1] [Citation(s) in RCA: 14] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/14/2023]
Abstract
BACKGROUND Membranous glomerulonephritis (MGN) may cause proteinuria as the main complication and is a strong risk factor for end-stage renal disease. Current therapeutic regimens provide only partial renoprotection. Data derived from both animal and human studies provide a scientific basis for the use of pentoxifylline as an antiproteinuric agent. OBJECTIVE This study was designed to evaluate the antiproteinuric effect of add-on pentoxifylline therapy in non-diabetic patients with MGN. STUDY DESIGN This was a double-blind, placebo-controlled trial. SETTING Non-diabetic patients with histologically proven MGN and urinary protein excretion (UPE) > 500 mg/24 h, entered a 6-month study period. Enrolled patients were selected from a university and three private clinics. INTERVENTION Patients were assigned to one of the two treatment groups: pentoxifylline 400 mg two or three times a day, or matching placebo. MAIN OUTCOME MEASURES Baseline and follow-up assessments included estimated glomerular filtration rate (eGFR) and UPE. Differences in the changes in variables within the placebo and pentoxifylline treatment groups during the study period were assessed using Friedman's test. RESULTS Treatment with pentoxifylline for 6 months resulted in a significant reduction of mean UPE (p < 0.001) along with a slight, non-significant increase of eGFR, in comparison to the mean UPE and eGFR increase in the placebo group. CONCLUSION This study showed that add-on therapy of pentoxifylline in MGN was beneficial, and could be considered as a potential new therapeutic indication for the drug in such kidney diseases.
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Affiliation(s)
- Shirinsadat Badri
- Department of Clinical Pharmacy, School of Pharmacy, Tehran University of Medical Sciences, 1417614411, Tehran, Iran
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Verma P, Jahan S, Kim TH, Goyal PK. Management of Radiation Injuries by Panax ginseng Extract. J Ginseng Res 2013; 35:261-71. [PMID: 23717069 PMCID: PMC3659536 DOI: 10.5142/jgr.2011.35.3.261] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/18/2010] [Revised: 01/11/2011] [Accepted: 01/11/2011] [Indexed: 12/16/2022] Open
Abstract
Chemical radiation protection is an important strategy to protect living beings against the deleterious effects of radiation. In the present study, the radioprotective effect of hydro-alcoholic extract of Panax ginseng extract (PGR-HAE) was studied on radiation-induced deleterious alterations in Swiss albino mice. Oral administration of such extract (25 mg/kg b wt/day/animal) for 5 consecutive days, half an h. before whole-body exposure to 6 Gy gamma radiation, enhanced the 30 days survival and also inhibited the radiogenic sickness, weight loss and life shortening. PGR-HAE ameliorated radiation induced depletion in blood constituents at different necropsy intervals between 12 h to 30 d, and significantly increased the number of femoral spleen colony forming units that survived after irradiation. Furthermore, it checked depletion of glutathione and antioxidant enzymes (superoxide dismutase, catalase, and glutathione S-transferase) as well as elevation of lipid peroxidation (LPO) level in blood and liver. The significant reduction in the yield of LPO demonstrates that PGR-HAE protects the membranes against radiation-induced oxidative damage. These findings conclude that such plant extract provides significant radioprotection, and it may be potentially valuable in the prevention of injuries caused during planned and unplanned radiation exposure.
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Affiliation(s)
- Preeti Verma
- Radiation & Cancer Biology Laboratory, Department of Zoology, University of Rajasthan, Jaipur 302004, India
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Chandrasekharan DK, Nair CKK. Studies on Silver Nanoparticle–Glycyrrhizic Acid Complex as a Radioprotector and an Adjuvant in Radiotherapy Under In Vivo Conditions. Cancer Biother Radiopharm 2012; 27:642-51. [DOI: 10.1089/cbr.2012.1286] [Citation(s) in RCA: 10] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/16/2022] Open
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Kang SW. Effect of phosphodiesterase inhibitor on diabetic nephropathy. Korean J Intern Med 2012; 27:151-3. [PMID: 22707885 PMCID: PMC3372797 DOI: 10.3904/kjim.2012.27.2.151] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/12/2012] [Accepted: 04/23/2012] [Indexed: 11/29/2022] Open
Affiliation(s)
- Shin-Wook Kang
- Department of Internal Medicine, Brain Korea 21, Severance Biomedical Science Institute, Yonsei University College of Medicine, Seoul, Korea
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Soler MJ, Riera M, Gutierrez A, Pascual J. New options and perspectives for proteinuria management after kidney transplantation. Transplant Rev (Orlando) 2012; 26:44-52. [PMID: 22137732 DOI: 10.1016/j.trre.2011.07.006] [Citation(s) in RCA: 9] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/26/2011] [Accepted: 07/28/2011] [Indexed: 12/31/2022]
Abstract
Proteinuria has been strongly correlated with reduced function and graft survival in kidney-transplanted patients. Data regarding new strategies in proteinuria treatment and subsequent allograft survival are lacking. Similarities between chronic graft injury and chronic kidney disease (CKD) suggest that the same therapeutic antiproteinuric tools should be effective in kidney-transplanted patients. The classic strategies to decrease proteinuria such as blood pressure control, nicotine cessation, low-salt diet, and maintaining an ideal body weight seem to be not enough to achieve proteinuria control. Improvements in our understanding of the pathogenesis of CKD have led to the identification of several novel targets for proteinuria management. In this review, we discuss novel pharmacological approaches that aim to decrease proteinuria in CKD patients, including the use of direct renin inhibitors, vitamin D analogs, pentoxifylline, and endothelin receptor antagonists. We also discuss the promise of using antifibrotic agents to treat proteinuria. The identification of new biomarkers of CKD and its progression can help in the selection of the most effective treatment for decreasing proteinuria and maintaining kidney function.
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Affiliation(s)
- María José Soler
- Department of Nephrology, Hospital del Mar-IMIM, Barcelona, Spain.
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No association of monocyte chemoattractant protein-1 -2518 A/G polymorphism with the risk of primary glomerulonephritis in the Polish population. Mol Biol Rep 2011; 39:5933-41. [PMID: 22203484 DOI: 10.1007/s11033-011-1405-y] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/12/2011] [Accepted: 12/17/2011] [Indexed: 12/11/2022]
Abstract
Various studies have indicated that chemokines such as monocyte chemotactic protein-1 (MCP-1) play an important role in the pathogenesis of primary glomerulonephritis (GN) and other glomerular diseases. Moreover, patients with primary GN display aberrant galactosylation of the O-linked carbohydrate moieties of IgA. Therefore, we analysed the distribution of the functional MCP-1 -2518 A > G (rs 1024611) and 1 beta 1,3-galactosyltransferase (C1GalT1) 1365 A > G (rs1047763) polymorphic variants in patients with primary GN (n = 144) and controls (n = 437) in a sample of the Polish population. We did not find a significant difference in the prevalence of the MCP-1 -2518 A > G and C1GalT1 1365 A > G polymorphisms in patients with primary GN and healthy individuals. Odds Ratio (OR) for GN patients with the MCP-1 -2518 GG genotype was 0.869 (95% CI = 0.410-1.840, P = 0.7130), and OR of the -2518 GG and -2518AG genotypes was 1.004 (95% CI = 0.689-1.464, P = 0.9836). OR for C1GalT1 1365AA genotype was 0.484 (95% CI = 0.181-1.293, P = 0.1402) and OR of the 1365AA and 1365AG genotypes was 0.839 (95% CI = 0.573-1.228, P = 0.3651). We also did not observe a difference in the distribution of alleles between patients and controls. The MCP-1 -2518 G allelic OR was 0.976 (95% CI = 0.725-1.314, P = 0.8744). The OR for the C1GalT1 1365A allele was 0.816 (95% CI = 0.596-1.118, P = 0.205). Moreover, there was no significant association between the MCP-1 -2518 A > G and C1GalT1 1365 A > G genotypes with different morphological types of primary GN or clinical manifestations. Our observations indicate that the MCP-1 -2518 A > G and C1GalT1 1365 A > G polymorphisms might not be a risk factor in the incidence of primary GN in the Polish population.
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Hu Y, Guo DH, Liu P, Cao JJ, Wang YP, Yin J, Zhu Y, Rahman K. Bioactive components from the tea polyphenols influence on endogenous antioxidant defense system and modulate inflammatory cytokines after total-body irradiation in mice. PHYTOMEDICINE : INTERNATIONAL JOURNAL OF PHYTOTHERAPY AND PHYTOPHARMACOLOGY 2011; 18:970-975. [PMID: 21498061 DOI: 10.1016/j.phymed.2011.02.012] [Citation(s) in RCA: 28] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 08/28/2010] [Revised: 01/05/2011] [Accepted: 02/20/2011] [Indexed: 05/30/2023]
Abstract
The present study aimed to evaluate the radioprotective efficacy of green tea polyphenols and the component ingredients against irradiated-induced damage in mice and elucidate the underlying mechanisms. Green tea polyphenols (GTP 50, 50 and 100 mg/kg, p.o. daily) and its four individual components (25 and 50 mg/kg, p.o. daily) were administrated to the irradiated-injured mice for 21 days. The radioprotective effect on the hematopoietic system, serum cytokines, and endogenous antioxidant enzymes was studied. GTP 50 significant revert the irradiated-induced decline in hematological parameters (RBCs, WBCs, Hb), meanwhile, protected antioxidant defense system, as evidenced by decreased of serum lipid peroxidation (malonyldialdehyde) and elevation the antioxidant enzyme superoxide dismutase (SOD). Among the GTP components, catechin showed the best effect on elevation of hematological parameters, and epigallocatechin gallate showed the best antioxidant activity. Moreover GTP and its bioactive components (catechin, epigallocatechin and epigallocatechin-3-gallate) assisted in decreasing the leukocytopenia seen after whole mice irradiation and significantly reduced the elevated serum inflammatory cytokines (TNF-α, IL-1β, and IL-6). Green tea polyphenols have a potential to be developed as radioprotective agents against irradiated-induced toxicity. Furthermore the antioxidant and anti-inflammatory activities of GTP can be attributed to the interaction of the different components through multiple and synergistic mechanisms.
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Affiliation(s)
- Yuan Hu
- Dept. of Clinical Pharmacology and Pharmacy, Centre of Pharmacy, Chinese PLA General Hospital, Beijing 100853, China
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Abstract
This chapter describes the effects of the natural methylxanthines caffeine and theophylline on kidney function. Theophylline in particular was used traditionally to increase urine out put until more potent diuretics became available in the middle of the last century. The mildly diuretic actions of both methylxanthines are mainly the result of inhibition of tubular fluid reabsorption along the renal proximal tubule. Based upon the use of specific adenosine receptor antagonists and the observation of a complete loss of diuresis in mice with targeted deletion of the A1AR gene, transport inhibition by methylxanthines is mediated mainly by antagonism of adenosine A1 receptors (A1AR) in the proximal tubule. Methylxanthines are weak renal vasodilators, and they act as competitive antagonists against adenosine-induced preglomerular vasoconstriction. Caffeine and theophylline stimulate the secretion of renin by inhibition of adenosine receptors and removal of the general inhibitory brake function of endogenous adenosine. Since enhanced intrarenal adenosine levels lead to reduced glomerular filtration rate in several pathological conditions theophylline has been tested for its therapeutic potential in the renal impairment following administration of nephrotoxic substances such as radiocontrast media, cisplatin, calcineurin inhibitors or following ischemia-reperfusion injury. In experimental animals functional improvements have been observed in all of these conditions, but available clinical data in humans are insufficient to affirm a definite therapeutic efficacy of methylxanthines in the prevention of nephrotoxic or postischemic renal injury.
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Affiliation(s)
- Hartmut Osswald
- Department of Pharmacology and Toxicology, University of Tübingen, Wilhelmstrasse 56, 72074, Tübingen, Germany
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Verma P, Sharma P, Parmar J, Sharma P, Agrawal A, Goyal PK. Amelioration of radiation-induced hematological and biochemical alterations in Swiss albino mice by Panax ginseng extract. Integr Cancer Ther 2010; 10:77-84. [PMID: 20702497 DOI: 10.1177/1534735410375098] [Citation(s) in RCA: 21] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022] Open
Abstract
BACKGROUND This study was carried out to observe the radioprotective effect of Panax ginseng root extract (PGE) against radiation-induced hematological and biochemical alterations in blood and liver of mice. Materials and methods. Adult Swiss albino mice were exposed to 6 Gy gamma radiation in the presence (experimental) or absence (control) of PGE to study the quantitative and qualitative alterations in the blood and liver. RESULTS Radiation exposure resulted in a significant decline (P<.001) in erythrocyte count, hemoglobin (Hb), and hematocrit (Hct) in peripheral blood. Maximum changes in all the parameters were observed on day 3 after irradiation. In contrast, PGE-pretreated irradiated animals showed a significant increase in erythrocyte, Hct, and Hb values compared with irradiated controls. Furthermore, a significant elevation in lipid peroxidation level over normal was recorded in irradiated control mice, whereas this increase was considerably lesser in PGE pretreated animals. Likewise, pretreatment with PGE caused a significant increase in glutathione levels in serum as well as in liver in comparison to irradiated controls. CONCLUSION From this study, it is clearly evident that PGE provides protection against radiation-induced hematological and biochemical alterations in Swiss albino mice.
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Prolonged administration enhances the renoprotective effect of pentoxifylline via anti-inflammatory activity in streptozotocin-induced diabetic nephropathy. Inflammation 2010; 33:137-43. [PMID: 19921414 DOI: 10.1007/s10753-009-9167-6] [Citation(s) in RCA: 13] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/13/2023]
Abstract
The beneficial effects of pentoxifylline (PTX), which has an anti-inflammatory and renoprotective effect in diabetic nephropathy, are not completely understood. This study investigates whether prolonged administration of PTX (40 mg/kg, per oral) is effective in streptozotocin-induced diabetic nephropathy. The amount of urinary protein was higher in the diabetic rats than in the control rats. The amount remained unchanged after 4 weeks and decreased after 8 weeks of PTX treatment. Accumulation of monocyte chemoattractant peptide-1 (MCP-1) and mouse monoclonal anti-monocyte/macrophage antibody (ED-1) positive cells was higher in untreated diabetic rats than in the control rats. PTX administration ameliorated the urinary MCP-1 excretion and interstitial infiltration of ED-1 positive cells at 4 weeks. Further, in diabetic rats, administration of PTX for 4 weeks inhibited the renal inflammatory reaction, and when administration for 8 weeks, it prevented proteinuria. These findings support the hypothesis that prolonged administration enhances the protective effects of PTX.
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Abstract
PURPOSE OF REVIEW Childhood chronic kidney disease usually progresses towards end-stage renal failure once a critical impairment of renal function has occurred. This process is largely independent of the underlying renal disease. Recent clinical trials have provided evidence that the progressive course of chronic kidney disease can be slowed substantially by pharmacological intervention. RECENT FINDINGS Hypertension and proteinuria are the most important independent risk factors for renal disease progression in both adult and pediatric nephropathies. Pharmacological blockade of the renin-angiotensin system provides efficient control of blood pressure and proteinuria, and superior long-term renoprotection compared with other antihypertensive agents. Recent pediatric evidence supports the renoprotective efficacy of tight blood pressure control aiming for the low-normal range. In addition, promising preliminary findings suggest an additional renoprotective potential by correction of metabolic acidosis and hyperuricemia and by administration of antiproliferative and antioxidative drugs. SUMMARY Pharmacological renoprotection currently focuses on antihypertensive and antiproteinuric treatment by blockade of the renin-angiotensin system. Intensified blood pressure control can improve 5-year renal survival by 35% in children with chronic kidney disease. Additional complementary strategies under current clinical evaluation bear potential to improve renal survival even further.
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Laczy B, Cseh J, Mohás M, Markó L, Tamaskó M, Koszegi T, Molnár GA, Wagner Z, Wagner L, Wittmann I. Effects of pentoxifylline and pentosan polysulphate combination therapy on diabetic neuropathy in type 2 diabetes mellitus. Acta Diabetol 2009; 46:105-11. [PMID: 18839054 DOI: 10.1007/s00592-008-0064-5] [Citation(s) in RCA: 14] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/25/2007] [Accepted: 09/12/2008] [Indexed: 01/14/2023]
Abstract
Vascular dysfunction, including impaired perfusion has a pivotal role in the pathogenesis of microvascular complications in diabetes mellitus. Both pentoxifylline (PF) and pentosan polysulphate (PPS) are known to improve microcirculation. Antioxidant and antiproteinuric effects of PF are also known. In a placebo-controlled study, we determined the possible efficacy of PF-PPS combination therapy on diabetic neuropathy and nephropathy in type 2 diabetic patients. Patients in Verum group (n = 77) received PF-PPS infusions (100-100 mg/day) for 5 days. Control diabetics (Placebo group; n = 12) were given only saline infusions. Specialized cardiovascular autonomic reflex tests, vibration threshold values and urinary albumin excretion were assessed before and after therapy. In Verum group, autonomic score, indicating the severity of cardiac autonomic dysfunction, decreased after therapy (p < or = 0.001). Of the reflexes, deep breath and handgrip tests also improved after therapy (p < or = 0.001). Vibration threshold values, an indicator of the loss of sensory nerve function, were increased after therapy (p < or = 0.001). Results of cardiac autonomic tests and vibration threshold values remained unaltered in Placebo group. Majority of patients had normalbuminuria, which was not affected by PF-PPS. In conclusion, short-term PF-PPS therapy was effective on cardiovascular autonomic function and vibration perception, whereas it failed to reduce albuminuria within normal range in type 2 diabetic patients.
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Affiliation(s)
- Boglárka Laczy
- Second Department of Medicine and Nephrological Center, Faculty of Medicine, University of Pecs, Pacsirta u. 1., 7624, Pecs, Hungary
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Vilayur E, Harris DCH. Emerging therapies for chronic kidney disease: what is their role? Nat Rev Nephrol 2009; 5:375-83. [PMID: 19455178 DOI: 10.1038/nrneph.2009.76] [Citation(s) in RCA: 65] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/11/2022]
Abstract
The prevalence of chronic kidney disease (CKD) is increasing worldwide. The best therapies currently available focus on the control of blood pressure and optimization of renin-angiotensin-aldosterone system blockade. Currently available agents are only partially effective against hard end points such as the development of end-stage renal disease and are not discussed in this Review. Many other agents have been shown to reduce proteinuria and delay progression in animal models of CKD. Some of these agents, including tranilast, sulodexide, thiazolidinediones, pentoxifylline, and inhibitors of advanced glycation end-products and protein kinase C, have been tested to a limited extent in humans. A small number of randomized controlled human trials of these agents have used surrogate markers such as proteinuria as end points rather than hard end points such as end-stage renal disease or doubling of serum creatinine level. Emerging therapies that specifically target and reverse pathological hallmarks of CKD such as inflammation, fibrosis and atrophy are needed to reduce the burden of this chronic disease and its associated morbidity. This Review examines the evidence for emerging pharmacological strategies for slowing the progression of CKD.
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Affiliation(s)
- Eswari Vilayur
- Department of Renal Medicine, Westmead Hospital, Westmead, NSW, Australia.
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Abstract
Diabetes and its complications have become a public health problem. One of the most important complications is diabetic nephropathy, which is nowadays the main cause of chronic renal failure. In spite of our greater understanding of this complication, the intimate mechanisms leading to the development and progression of renal injury are not well understood. New perspectives in activated innate immunity and inflammation appear to be relevant factors in the pathogenesis of diabetes. Moreover, different inflammatory molecules, including adipokines, Toll-like receptors, chemokines, adhesion molecules and pro-inflammatory cytokines, may be critical factors in the development of microvascular diabetic complications, including nephropathy. This new pathogenic perspective leads to important therapeutic considerations, with new pathogenic pathways becoming important therapeutic targets that can be translated into clinical treatments for diabetic nephropathy.
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Perkins RM, Aboudara MC, Uy AL, Olson SW, Cushner HM, Yuan CM. Effect of pentoxifylline on GFR decline in CKD: a pilot, double-blind, randomized, placebo-controlled trial. Am J Kidney Dis 2009; 53:606-16. [PMID: 19216016 DOI: 10.1053/j.ajkd.2008.11.026] [Citation(s) in RCA: 61] [Impact Index Per Article: 4.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/27/2008] [Accepted: 11/12/2008] [Indexed: 12/25/2022]
Abstract
BACKGROUND Pentoxifylline is a nonspecific phosphodiesterase inhibitor with anti-inflammatory properties. It reduces proteinuria in patients with glomerular disease, although its impact on glomerular filtration rate (GFR) is unknown. We hypothesized that pentoxifylline would slow the estimated GFR decrease in patients with chronic kidney disease at high risk of progression. STUDY DESIGN Pilot randomized double-blind placebo-controlled trial. SETTING & PARTICIPANTS 40 outpatients with decreased GFR, hypertension, and proteinuria greater than 1 g/24 h currently treated with angiotensin-converting enzyme inhibitors, angiotensin receptor blockers, or the combination and followed up in a nephrology clinic at a tertiary medical care facility. INTERVENTION Pentoxifylline, 400 mg twice daily, or matching placebo. OUTCOMES Difference in rates of estimated GFR change during the 1-year study period between the 2 groups. MEASUREMENTS Estimated GFR (4-variable Modification of Diet in Renal Disease Study equation) and proteinuria by 24-hour urine collection were assessed at baseline and 6 and 12 months after enrollment. RESULTS Baseline characteristics were similar between the 2 groups. At 1 year, the mean estimated GFR decrease was significantly less in the pentoxifylline group than the placebo group (-1.2 +/- 7.0 versus -7.2 +/- 8.2 mL/min/1.73 m2/y; mean difference, -6.0 mL/min/1.73 m2/y; 95% confidence interval, -11.4 to -0.6; P = 0.03). For pentoxifylline-treated participants, the mean estimated GFR decrease during treatment was slower compared with the year before study enrollment (-9.6 +/- 11.9 mL/min/1.73 m2/y; mean difference, -8.4 mL/min/1.73 m2/y; 95% confidence interval, -14.8 to -2.1; P = 0.01). Proteinuria was not different between the pentoxifylline and placebo groups at baseline, 6 months, or 1 year. LIMITATIONS Small sample size and incomplete follow-up. CONCLUSIONS Pentoxifylline may slow the estimated GFR decrease in high-risk patients. This may be independent of its antiproteinuric properties and warrants further investigation.
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Affiliation(s)
- Robert M Perkins
- Nephrology Service, Madigan Army Medical Center, Fort Lewis, WA 98431, USA.
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Abouelella AMK, Shahein YE, Tawfik SS, Zahran AM. Phytotherapeutic effects of Echinacea purpurea in gamma-irradiated mice. J Vet Sci 2008; 8:341-51. [PMID: 17993747 PMCID: PMC2868149 DOI: 10.4142/jvs.2007.8.4.341] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/17/2022] Open
Abstract
Echinacea (E.) purpurea herb is commonly known as the purple coneflower, red sunflower and rudbeckia. In this paper, we report the curative efficacy of an Echinacea extract in γ-irradiated mice. E. purpurea was given to male mice that were divided into five groups (control, treated, irradiated, treated before irradiation & treated after irradiation) at a dose of 30 mg/kg body weight for 2 weeks before and after irradiation with 3 Gy of γ-rays. The results reflected the detrimental reduction effects of γ-rays on peripheral blood hemoglobin and the levels of red blood cells, differential white blood cells, and bone marrow cells. The thiobarbituric acid-reactive substances (TBARs) level, Superoxide dismutase (SOD) and glutathione peroxidase (GSPx) activities and DNA fragmentation were also investigated. FT-Raman spectroscopy was used to explore the structural changes in liver tissues. Significant changes were observed in the microenvironment of the major constituents, including tyrosine and protein secondary structures. E. purpurea administration significantly ameliorated all estimated parameters. The radio-protection effectiveness was similar to the radio-recovery curativeness in comparison to the control group in most of the tested parameters. The radio-protection efficiency was greater than the radio-recovery in hemoglobin level during the first two weeks, in lymphoid cell count and TBARs level at the fourth week and in SOD activity during the first two weeks, as compared to the levels of these parameters in the control group.
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Affiliation(s)
- Amira M K Abouelella
- Radiation Biology Department, National Centre for Radiation Research and Technology, Cairo, Egypt
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Diskin CJ, Stokes TJ, Dansby LM, Radcliff L, Carter TB. Understanding the pathophysiology of hemodialysis access problems as a prelude to developing innovative therapies. ACTA ACUST UNITED AC 2008; 4:628-38. [DOI: 10.1038/ncpneph0947] [Citation(s) in RCA: 22] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/01/2008] [Accepted: 08/06/2008] [Indexed: 11/09/2022]
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Gupta U, Jahan S, Chaudhary R, Pradeep Kumar Goyal. Amelioration of Radiation-induced Hematological and Biochemical Alterations by Alstonia scholaris (a Medicinal Plant) Extract. Integr Cancer Ther 2008; 7:155-61. [DOI: 10.1177/1534735408322850] [Citation(s) in RCA: 11] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022] Open
Abstract
The radioprotective efficacy of a hydro-alcoholic extracted material from the bark of Alstonia scholaris (ASE) was studied in mice against radiation-induced hematological and biochemical alterations. Swiss albino mice were administered ASE (100 mg/kg body weight/d for 5 consecutive day) orally prior to whole-body gamma irradiation (7.5 Gy). Radiation exposure resulted in a significant decline ( P < .001) in erythrocytes and hemoglobin until the third day, following a gradual recovery (ie, day 7), but these values did not reach normal values during the remainder of the animals' life span. Hematocrit percentage declined significantly ( P < .001) until day 15. In contrast, ASE-pretreated irradiated animals had significantly higher erythrocyte, hematocrit, and hemoglobin values than the irradiated controls. Furthermore, a significant elevation in lipid peroxidation level over normal was recorded in gamma-irradiated mice, whereas this increase was considerably lower in ASE-pretreated animals. Pretreatment with ASE caused a significant increase in glutathione levels in serum as well as in liver in comparison to irradiated animals. This study showed that ASE protects against radiation-induced hematological and biochemical alterations in Swiss albino mice.
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Affiliation(s)
- Uma Gupta
- Radiation and Cancer Biology Laboratory, Department of Zoology, University of Rajasthan, Jaipur, India
| | - Swafiya Jahan
- Radiation and Cancer Biology Laboratory, Department of Zoology, University of Rajasthan, Jaipur, India
| | - Ranu Chaudhary
- Radiation and Cancer Biology Laboratory, Department of Zoology, University of Rajasthan, Jaipur, India
| | - Pradeep Kumar Goyal
- Radiation and Cancer Biology Laboratory, Department of Zoology, University of Rajasthan, Jaipur, India,
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Lin SL, Chen YM, Chiang WC, Wu KD, Tsai TJ. Effect of Pentoxifylline in Addition to Losartan on Proteinuria and GFR in CKD: A 12-Month Randomized Trial. Am J Kidney Dis 2008; 52:464-74. [DOI: 10.1053/j.ajkd.2008.05.012] [Citation(s) in RCA: 53] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/31/2007] [Accepted: 05/01/2008] [Indexed: 11/11/2022]
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Catapano F, Chiodini P, De Nicola L, Minutolo R, Zamboli P, Gallo C, Conte G. Antiproteinuric Response to Dual Blockade of the Renin-Angiotensin System in Primary Glomerulonephritis: Meta-analysis and Metaregression. Am J Kidney Dis 2008; 52:475-85. [DOI: 10.1053/j.ajkd.2008.03.008] [Citation(s) in RCA: 54] [Impact Index Per Article: 3.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/31/2007] [Accepted: 03/03/2008] [Indexed: 11/11/2022]
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