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Kidney Week

Abstract: FR-PO252

Treatment of CKD Stage III-IV Diabetic Nephropathy Patients with Tripterygium wilfordii Hook F Extract and the Serum and Urine Metabolomic Analysis

Session Information

Category: Diabetic Kidney Disease

  • 602 Diabetic Kidney Disease: Clinical

Author

  • Li, Ming-Xi, Peking Union Medical College Hospital, Beijing, China
Background

Diabetic nephropathy (DN) is the most common cause of end-stage renal failure. Although angiotensin II receptor blockers (ARBs) can be used to attenuate proteinuria in DN patients, their efficacy remains limited in CKD stage III-IV DN. This study aimed to evaluate the efficacy of Tripterygium wilfordii Hook F (TwHF) extract in the treatment of type 2 DN patients with CKD stage III-IV and compare the serum and urinary changes of metabolic pathways after TwHF treatment using metabolomics.

Methods

From Oct. 2018 to Jan. 2019, type 2 DN patients with 25≤eGFR<60 ml/min/1.73m2 followed up in renal outpatient clinic of Peking Union Medical College Hospital, who were receiving ARBs and still suffered from severe proteinuria were enrolled as treatment group (TwHF extract 60mg daily). The patients matched by gender, age, proteinuria, and serum creatinine were selected as controls. treated with the maximum dose of ARBs. The urinary protein and eGFR levels were measured at one month after the commencement of treatment. The serum and urine metabolomic analysis before and after treatment in the TwHF group, using UPLC-LTQ-Orbitrap high-resolution mass spectrometry was performed to detect the changes in metabolic pathways.

Results

A total of 28 patients were included, 14 patients (52.9±15.2 ys, eGFR 45±16ml/min/1.73m2) in the TwHF group and 14 patients in the control group (53.1±11.6 ys, eGFR 46±19ml/min/1.73 m2). After 1 month treatment, the urinary protein of the TwHF group decreased significantly from 6.2±2.0g/24h to 3.4±1.7g/24h (P<0.05), and the control group decreased significantly from 5.0±1.8g/24h to 3.5±2.0g/24h (P<0.05). There was a significant difference in the reduction rate of proteinuria between the two groups (P=0.03). There were 18 metabolic pathways changed significantly in the urine metabolomic analysis after treatment, including leukotriene, peroxidase fatty acid, and eicosapentaenoic acid metabolic pathways which were associated with inflammation and oxidative stress. A similar change of metabolic pathways was found in the serum metabolomic analysis.

Conclusion

The TwHF extract can reduce the urine protein level of type 2 DN patients with CKD stage III-IV. The serum and urine metabolomic analysis implies TwHF extract may have anti-inflammation and attenuate oxidative stress effects.