Treatment of Kidney Failure with Chinese herb and with Inosine

by: Wang Qia Hui, Liu Cai Hong, First People Hospital, Henan Science Technology University, Pin Ting Shan City, Henan province.

During the years of 1990 to 2001, the  authors use IV of inosine and orally giving wen pi tang to treat 94 patients with chronic kidney function failure and lower their BUN and Scr (serum creatinine). The result was satisfactory.  The result is as follow:

1. Chinical information

1.1 Selection of patients for the study

94 patients were all inpatients of our hospital. Among them are 62 males, 32 female, age 23 to 62.  According teaching material of the 5th edition of "internal Medicine" 《內科學》, the diagnosis were: 66 patients with chronic nephritis, 16 with pyelonephritis, 8 with kidney arteriolar sclerosis, 4 with diabetes with kidney failure.  All patients were with lower limb edema, nausea, lack of appetite, limb fullness, tired and lack of energy, lack of urine, pale tongue with thin white fur, deep and weak pulse.  The TCM diagnosis is pi shen yang xu (脾腎陽虛).

1.2 Group divisions:

The patients were divided into 3 groups:

1. Modern (Western) & traditional Chinese medicine combination group

2. Traditional Chinese medicine group

3. Modern (Western) medicine group

The 3 groups there was no statistical significance in differences in ages, sexes, Bun and Scr.
 

2. Therapy Method:

• Modern (Western) medicine group: 1 g of Inosine with 10% of GS 250 to 500 ml IV application. Once a day for 30 days.

• Traditional Chinese medicine group: Using wen pi tang. If edema is serious add bai mao gen 10 g.  taken orally for 30 days

• Combined therapy group: IV application of Inosine and  with wen pi tang taken orally, for 30 days..
   

3. The Result:

Before and after treatment, measure the value of BUN and Scr

If BUN lowered to ≧０.３６ｍｍｏ１／Ｌ and at the same time the Scr lowered to ≧７０μ ｍｏ１／Ｌ, then it was deemed effect. If one of the value did not reach the designated value, it was deemed ineffective. The result was as follow:
 

４　討論
　　各種原因的慢性腎臟病變逐漸發展均會出現腎功能不全，ＢＵＮ和Ｓｃｒ上升後便進入氮質血症期；若繼續發展， 肌酐清除率降到只有正常的２５％以下時，即進入尿毒症期uremia。當病人尚處在氮質血症期，還沒有指征進行血液淨化療法時，如何延長患者殘留的有限腎功能，使 其推遲進入尿毒症期是關鍵。溫脾湯出自《千金要方》，方中重用附子，乾薑，党參，甘草，溫陽補脾，扶助正氣；配伍大黃瀉熱毒，蕩積滯，行瘀血達到胃腸 透析的目的；加用白茅根以利尿消腫。從現代醫學角度來看，肌苷加溫脾湯從改腎臟血液供應和促進氮的代謝方面發揮了作用，肌苷可保護腎小管上皮細胞，使 供氧不足的血管擴張，解除了血管痙攣，從而改善腎臟的血液供應。大黃的有效成分為大黃提取物可以減少，消除血液中的尿毒症毒素（如甲基胍和胍基琥珀酸 ），改善氨基酸成分，改善低鈣血症和高磷酸血症，並能放寬飲食的限制，從而改善營養不良。附子能使衷竭機體功能激活，增加腎組織血流量，從而使腎功能 不全得以明顯改善。溫脾湯和肌苷注射液來源方便，價格適中，無不良反應，是腎功能不全患者較好的用藥選擇。

（收稿日期：２００３－０１－１３）
摘自《中國中醫藥信息雜誌2003年6月　第10卷　第6期》
 

註：

肌苷: Inosine

Common Reference Ranges of Scr (serum creatinine):

Male Adults:  0.7 - 1.5 mg/dL (62 -133 µmol/L), Female Adult: 0.5-1.2 mg/dl

Pediatrics 0.2 - 0.7 mg/dL (18 - 62µmol/L)

BUN (Blood urine nitrogen):

Adults:    7-20 mg/dl

尿素氮 (BUN) 是蛋白質的代謝產物。是經腎臟分泌而經由尿液排出於體外。如 果 血中尿素氮的濃度升高，即為腎功能異常。

能影響 BUN 的檢 驗 因素有：

會使血中尿素氮濃度暫時性上升有：

心力衰竭，缺乏水份，吃大量蛋白質食物，上消化道出血，感染，使用類固醇藥物，及腎血流量不足等因素，和一下药物：

Allopurinol, Aminoglycosides, Amphotericin B, Bacitracin, Carbamazepine, Cephalosporins, Chloral hydrate, Cisplatin, Colistin, Furosemide, Gentamicin, Guanethidine, High-dose aspirin, Indomethacin, Methicillin, Methotrexate, Methyldopa, Neomycin, Penicillamine, Polymyxin B, Probenecid, Propranolol, Rifampin, Spironolactone, Tetracyclines, Thiazide diuretics, Triamterene, Vancomycin,

會使尿 素氮(BUN) 暫時性降 低有：

肝臟病，肝損傷能，懷 孕十三周後，和一下藥物：

Chloramphenicol, Streptomycin。

所以BUN不能准确地反映腎功能。
如果因為腎臟病導致 BUN 上升時，往往腎臟病已進展到相當的程度，喪失早期偵測的意義，所以檢驗 BUN 不能發现早 期 腎臟病。

檢驗BUN 適合腎臟病患者用來監控病情，但不適合單獨用來篩檢腎臟病。 對 早期腎臟病而言，尿蛋白及24小時尿液微白蛋白(24hr urince micro-albumin) 比 尿素氮 (BUN) 更準確。
血清肌酸酐(serum creatinine / Scr)是 非常穩定的腎功能指標，常用於評估腎功能障礙的嚴重程度，及腎臟病的病情監控，但不適用於篩 檢早期腎臟病。因為當血中肌酸酐濃度連續數次測定均為異常時，通常病情已進 展到不可逆的程度。血中的肌酸酐主要是來自於身體肌肉活動的代謝產物，而 每天的產量全部都經腎臟由尿液排泄。因此，腎功能有問題，無法完全排出每日所 產生肌酸酐，即會造成血中肌酸酐濃度上升的現象。上升越高，腎功能越不 好。血中肌酸酐的濃度與每個人的肌肉總量或體重多少與運動量有關，卻與肉食或水 份攝取無太多影响。肌 酸酐與血中尿素氮(BUN)合稱為尿毒，但肌酸酐的濃度高低，較血中尿素氮(BUN)更 能準確的顯示腎功能的好壞。
BUN (Blood urine nitrogen) test;   Urea is the metabolite of protein consumed. If the  kidneys are not able to remove urea from the blood normally, the BUN (blood urine nitrogen) level increases. This means that the kidneys are not functioning properly.

Factor that can increase BUN level:

• Heart failure,

• Dehydration,

• Diet high in protein

Factors that can decrease BUN level:

• Liver disease or damage because urea is made in the liver. 

• Second or third trimester of pregnancy.

Drugs that can increase BUN measurements include:

Allopurinol, Aminoglycosides, Amphotericin B, Bacitracin, Carbamazepine, Cephalosporins, Chloral hydrate, Cisplatin, Colistin, Furosemide, Gentamicin, Guanethidine, High-dose aspirin, Indomethacin, Methicillin, Methotrexate, Methyldopa, Neomycin, Penicillamine, Polymyxin B, Probenecid, Propranolol, Rifampin, Spironolactone, Tetracyclines, Thiazide diuretics, Triamterene, Vancomycin,

Drugs that can decrease BUN, measurements include:

Chloramphenicol, Streptomycin.

Small amounts of protein in the urine is called microalbuminuria. 尿中有微少的蛋白是稱 為微 白蛋白尿。