Approach to Early Detection and Management of Kidney Disease

The effectiveness of glomerular filtration is measured by serum urea (sU), which is generated in the liver, and serum creatinine (sCr), which is a breakdown product of muscle cells. Both sU and sCr have low predictive accuracy for renal injury, especially in the early stages of kidney disease, because they are evaluated when 60-70 percent of nephrons have already been damaged and kidney diseases have progressed to the point where dialysis or kidney transplantation are the only options. As a result, individuals face a variety of health issues as they approach death. As a result, early diagnosis of kidney injury using direct kidney injury markers, renal tubule injury markers, and proteomic genomic markers of kidney disorders from both urine and serum, as well as alternative treatment strategies for kidney disease management using medicinal plants, is now more important than ever. Tubular damage markers, such as KIM-1, proteomic and genomic markers from the proximal nephron, kidney functional markers, such as cystatin C, and oxidative stress markers, such as Malon di aldehyde (MDA), alpha Glutathione S Transferase (alpha GST). When renal tubules are stressed and wounded, key mediators such as IL-18, KIM-1, cystatin C, and GST emerge in urine. Terminellia arjuna (TA), a medicinal plant used in Ayurvedic medicine, includes phytoconstituents such as triterpenoids, tannins, flavonoids, and others that have been shown to have anti-cardiovascular, anti-cancer, anti-microbial, and nephroprotective characteristics. Antiuremic effects of aqueous bark extract of TA have been demonstrated in our laboratory on dehydration-induced uremic rats. As a result, the publication was written to look into kidney damage proteome and genomic biomarkers from both serum and urine in acetaminophen-induced renal problem rats, as well as to look into the therapeutic efficiency of phytocompounds from Terminalia arjuna bark (TA).

The first was to identify the best biomarkers for early screening of kidney disorders, whether they were plasma urea and creatinine or novel urinary low molecular weight protein biomarkers such as Interlukin-18 (IL-18), Kidney injury molecule-1 (KIM-1), and cystatin –C. Second, the therapeutic efficacy of Terminalia arjuna (MFTA) methanol fraction on urine new biomarkers.

Results demonstrated that APAP administration for 5 days, 10 days, and 15 days elevated novel urinary biomarkers such as IL-18, KIM-1, and cystatin-C by nearly twofolds and cystatin-C by nearly sixfolds compared to old biomarkers plasma urea and plasma creatinine. The protective impact of APAP with co-administration of MFTA was demonstrated by a decrease in established and new unique biomarkers such as Superoxide dismutase (SOD) and catalase, whereas the amount of malondialdehyde (MDA) increased. In APAP treatment rats, SDS-PAGE revealed new low molecular weight urine protein bands, whereas in normal rats, there was no band at this molecular level.

Conclusion: MFTA is the most potent nephroprotective drug, and urine low molecular proteins, rather than plasma urea and creatinine, are the best diagnostic tools for early diagnosis of kidney disease.

Author (s) Details

Deblina Giri
Research Unit, Department of Nutrition, Raja Narendralal Khan Women’s College, Midnapore-721102, Dist- Paschim Medinipur, West Bengal, India.

Dr. Koushik Das
Research Unit, Department of Nutrition, Belda College, Belda-721424, Dist- Paschim Medinipur, West Bengal, India.

Dilip Kumar Nandi
Department of Post Graduate Physiology of Raja Narendralal Khan Women’s College, Midnapore-721102, Dist- Paschim Medinipur, West Bengal, India.

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