Diabetic Nephropathy


Diabetes mellitus is a disorder of carbohydrate, protein and fat metabolism due to absolute insulin deficiency or resistance of body tissues to the circulating insulin. It’s characterized by chronic hyperglycemia with many complications which may be acute or chronic. One of the chronic complications of diabetic mellitus is damage to the kidneys, a condition known as diabetic nephropathy. Significant number of patients with diabetic nephropathy (20–40% of diabetic patients) progress to end-stage kidney failure with the need for dialysis or kidney transplantation.1

The presence of protein in the urine at a level known as microalbuminuria in a patient with diabetes mellitus signifies the presence of diabetic nephropathy. Diabetic nephropathy is the leading cause of end-stage kidney failure globally.2This is one of the causes of mortality among diabetic patients.

Persistent presence of protein in the urine results in damage to renal tubules. Some medications for blood pressure have been demonstrated to reduce albuminuria and delay the progression of diabetic nephropathy and are therefore the mainstay in the management of diabetic nephropathy.2Nevertheless, many diabetic patients still end up with end-stage kidney failure. This is a pointer to other possible mechanisms of kidney damage apart from those blocked by these medications.

Traditional Chinese medicine (TCM) has been widely used to treat and control diabetes and its complications such as diabetic nephropathy in many scientific researches.1 TCM has advantages over the conventional medical approaches in the prevention of diabetic complications because of less toxicity and/or side effects.1 These preparations are available in capsules, pills and decoction. While some contain single agent, others are combinations of two or more substances. Some of the TCM that have shown potential benefits are as follows:

  • Chaihuang Yishen granule (CHYS) is a combination of more than one substance and has shown potential therapeutic benefit in rats with diabetic nephropathy by preventing renal fibrosis.
  • Compound Rhizoma Coptidis Capsule (CRCC) composed of rhizoma coptidis, Kudzu root, dwarf lilyturf, and Loquat leaf. CRCC has demonstrated renal protective effects by slowing down the progression of DN in rat specimens.
  • Danggui buxue tang (DBT) slows the progression of diabetic nephropathy. In addition, it lowers the blood glucose and triglyceride.
  • Danggui Shaoyao San (DSS) contains six herbal substances. It prevents glomerular damage and affords a good blood sugar control in animal studies.
  • Hachimijiogan (HJG) is a popular herbal medicine in Japan with ability to reduce blood sugar and protein excretion in diabetic nephropathy. It may slow down the progression of kidney damage in diabetic patients by blocking the processes that are involved in diabetic nephropathy.

Other preparations that have shown benefits in diabetic nephropathy in animal studies include Fufang Xue Shuan Tong (FXST), Hachimijiogan (HJG), Hu-Lu-Ba-Wan (HLBW), Liuwei Dihuang Pill (LDP), Oryeongsan (Wulingsan), Oryeongsan (Wulingsan), Qizhi Jiangtang Capsule, Qiwei Granule (QWG), Shenkangwan (SKW), etc.

In a review of different studies on the effect of Chinese herbal medicine (CHM) on the level of protein in the urine in patients with diabetic nephropathy, Xiao et al. reviewed a total of 29 studies. As many as 84 different kinds of herbs were included in 29 herbal preparations.

One of the studies reviewed by Xiao et al. tested Arctiin compared with placebo (a drug that doesn’t contain any active ingredient) in patients with diabetic nephropathy. Arctiin, after two months of treatment, showed significant improvement reduction in protein excretio.2

Fourteen (14) different CHM were compared with blood pressure medications. The rates of protein/albumin excretion were assessed. Ten (10) trials reported significant improvement in the amount of protein in the urine after treatment with CHM compared with those treated with blood pressure medications. CHM showed significant improvement in proteinuria compared with blood pressure medications in 8 studies.2

Some studies also review Chinese Herbal Medicine plus blood pressure medications versus Placebo plus blood pressure medications. Silymarin and standard treatment showed significant improvement in the change of urinary albumin-creatinine ratio from baseline compared with placebo plus drugs. Turmeric plus medications showed significant improvement in the change of protein-creatinine ratio and proteinuria from baseline compared with placebo combined with medications.2

Seven studies reported no adverse effects during treatment while eight trials reported non-serious adverse events. Some of these include abdominal pain, diarrhea, and loose stools after taking Arctiin granule. These symptoms could be tolerated by patients. Overall, no serious adverse event was reported by any of the studies.

With rising incidence of diabetes mellitus, the number of people with diabetic nephropathy will continue to rise. Some blood pressure medications have been known to reduce the rate of protein excretion in diabetic patients but the percentage of diabetic patients with end-stage kidney failure is still rising. Thus, there is need for CHM either in combination with the above medications or as singular agent for the management of diabetic nephropathy.


  1. Sun G, Li C, Cui W, et al. Review of Herbal Traditional Chinese Medicine for the Treatment of Diabetic Nephropathy. Journal of Diabetes Research, 2016, 1-18. doi:10.1155/2016/5749857
  2. Xiao Y, Liu Y, Yu K. et al. The Effect of Chinese Herbal Medicine on Albuminuria Levels in Patients with Diabetic Nephropathy: A Systematic Review and Meta-Analysis. Evidence-Based Complementary and Alternative Medicine, 2013, 1-11. doi:10.1155/2013/937549


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