Herbal medicines as diuretics: A review of the scientific evidence

Objective To evaluate the effect of an aqueous extract of Phyllanthus niruri (Pn), a plant used in folk medicine to treat lithiasis, on the urinary excretion of endogenous inhibitors of lithogenesis, citrate, magnesium and glycosaminoglycans (GAGs).



Materials and methods The effect of chronic (42 days) administration of Pn (1.25 mg/mL/day, orally) was evaluated in a rat model of urolithiasis induced by the introduction of a calcium oxalate (CaOx) seed into the bladder of adult male Wistar rats. The animals were divided into four groups: a sham control (16 rats); a control+Pn (six); CaOx+water instead of Pn (14); and CaOx+Pn (22). Plasma and urine were collected after 42 days of treatment for biochemical analysis and the determination of urinary excretion of citrate, magnesium and GAGs. The animals were then killed and the calculi analysed.



Results The creatinine clearance or urinary and plasma concentrations of Na+, K+, Ca2+, oxalate, phosphate and uric acid were unaffected by Pn or the induction of lithiasis. Treatment with Pn strongly inhibited the growth of the matrix calculus and reduced the number of stone satellites compared with the group receiving water. The calculi were eliminated or dissolved in some treated animals (three of 22). The urinary excretion of citrate and magnesium was unaffected by Pn treatment. However, the mean (sd) urinary concentration of GAGs was significantly lower in rats treated with CaOx+Pn, at 5.64 (0.86) mg/g creatinine, than when treated with CaOx + water, at 11.78 (2.21) mg/g creatinine. In contrast, the content of GAGs in the calculi was higher in the CaOx + Pn rats, at 48.0 (10.4) g/g calculus, than in the CaOx + water group, at 16.6 (9.6) g/g calculus.



Conclusion These results show that Pn has an inhibitory effect on crystal growth, which is independent of changes in the urinary excretion of citrate and Mg, but might be related to the higher incorporation of GAGs into the calculi.

https://onlinelibrary.wiley.com/doi/pdf/10.1046/j.1464-410X.2002.02794.x

The effect of Phyllanthus niruri on urinary inhibitors of calcium oxalate crystallization and other factors associated with renal stone formation

The present study investigated the hypotensive responses to intravenous (i.v.) treatment with the essential oil of Alpinia zerumbet (EOAZ) and its main constituent, terpinen-4-ol (Trp-4-ol), in the experimental model of deoxycorticosterone-acetate (DOCA)-salt hypertensive rat. In both DOCA-salt hypertensive and uninephrectomized, normotensive rats, i.v. bolus injections of EOAZ (1-20 mg/kg) or Trp-4-ol (1-10 mg/kg) decreased mean aortic pressure (MAP) in a dose-related manner. However, hypotensive responses to Trp-4-ol were significantly greater than those evoked by the same doses of EOAZ (1-10 mg/kg). Treatment with DOCA-salt significantly enhanced the maximal percentage decreases in MAP evoked by EOAZ or Trp-4-ol. Likewise, both maximal percentage and absolute decreases in MAP elicited by i.v. injection of the ganglion blocker, hexamethonium (30 mg/kg), were significantly greater in DOCA-salt hypertensive than in control rats. In DOCA-salt hypertensive rats, neither hexamethonium (30 mg/kg, i.v.) nor methylatropine (1 mg/kg, i.v.) pretreatment affected the enhancement of EOAZ-induced hypotension. These results show that i.v. treatment with either EOAZ or Trp-4-ol dose-dependently decreases blood pressure in conscious DOCA-salt hypertensive rats, and this action is enhanced when compared with uninephrectomized controls. This enhancement could be related mainly to an increase in EOAZ-induced vascular smooth muscle relaxation rather than to enhanced sympathetic nervous system activity in this hypertensive model. The data further support our previous hypothesis that hypotensive effects of EOAZ are partially attributed to the actions of Trp-4-ol.

Antihypertensive effects of the essential oil of Alpinia zerumbet and its main constituent, terpinen‐4‐ol, in DOCA‐salt hypertensive conscious rats

Endothelium-dependent vasorelaxant effects of the essential oil from aerial parts of Alpinia zerumbet and its main constituent 1,8-cineole in rats.

AIDS and influenza are viral pandemics and remain one of the leading causes of human deaths worldwide. The increasing resistance of these diseases to synthetic drugs demands the search for novel compounds from plant-based sources. In this regard, the leaves and rhizomes of Alpinia zerumbet, a traditionally important economic plant in Okinawa, were investigated for activity against HIV-1 integrase (IN) and neuraminidase (NA). The aqueous extracts of leaves and rhizomes had IN inhibitory activity with IC(50) values of 30 and 188 μg/mL, whereas against NA they showed 50% inhibition at concentrations of 43 and 57 μg/mL, respectively. 5,6-Dehydrokawain (DK), dihydro-5,6-dehydrokawain (DDK), and 8(17),12-labdadiene-15,16-dial (labdadiene) were isolated from the rhizomes and were tested for enzyme inhibitions. DK and DDK strongly inhibited IN with IC(50) of 4.4 and 3.6 μg/mL, respectively. Against NA, DK, DDK, and labdadiene exhibited mixed type of inhibition with respective IC(50) values of 25.5, 24.6, and 36.6 μM and K(i) values ranging from 0.3 to 2.8 μM. It was found that DDK is a slow and time-dependent reversible inhibitor of NA, probably with a methoxy group as its functionally active site. These results suggest that alpinia could be used as a source of bioactive compounds against IN and NA and that DK and DDK may have possibilities in the design of drugs against these viral diseases.

HIV-1 integrase and neuraminidase inhibitors from Alpinia zerumbet.

In order to evaluate the potential diuretic effect of two natural products, Elephantopus scaber and Alpinia speciosa, a trial administration was carried out in ten healthy volunteers and the effects compared to the those of a placebo. The substances were given on different days, with a seven day interval between doses. The amount of substance administered to the subjects was five times the usual dose i.e. 7.5 g/100 ml and 0.8 g/100 ml respectively. The following parameters were measured: urinary and plasma sodium, potassium, uric acid, calcium, phosphate, urea, creatinine. The subjects were also examined clinically and total urinary volume was assessed. The only significant findings (p < 0.05) was a slight diuresis with Alpinia speciosa, which also lowered the diastolic (p < 0.05) and systolic (p < 0.01) blood pressures. No effect on electrolytes or renal function parameters was observed, and this probably excludes any renal tubular or glomerular effect from these substances.

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Evaluation of acute administration of natural products with potential diuretic effects, in humans

To evaluate renal function after the use of a low-osmolality radiological contrast medium (CM), we prospectively analyzed 39 patients submitted to the following examinations: arteriography (n = 32), phlebography (n = 3), computed tomography (n = 3), angioplasty (n = 1), and retrograde pyelography (n = 1). The patients were divided into three groups: group 1, control, formed by renal donors (CT, n = 11 and 11 exams); group 2, hypertensive patients (HYPT, n = 15 and 16 exams): and group 3, patients with diseases of multiple etiologies (MIX, n = 13 patients and 13 exams). Additionally, the patients were divided according to their renal function into: group 4, with a moderate deficit of renal function, creatinine clearance (CrCl) 25 to 60 mL/min (n = 15 patients and 15 exams); and group 5, with a mild deficit of renal function, CrCl ≥ 60 mL/min (n = 14 patients and 14 exams). The CM utilized was ioxaglic acid (Hexabrix) the incidence of acute renal failure (ARF) among the patients studied was 12.5% (5/40), an...

Nephrotoxicity of low-osmolality contrast media.

INTRODUCAO: O objetivo deste estudo foi avaliar o perfil epidemiologico dos pacientes e das dificuldades dos pacientes encaminhados, pelas unidades basicas de saude (UBS) ou outros hospitais, ao ambulatorio de triagem da disciplina de Nefrologia do Hospital Sao Paulo (UNIFESP) para avaliacao e tratamento de doencas renais. METODOS: No periodo de fevereiro a setembro de 2009, foram avaliados 341 pacientes encaminhados das UBS da cidade de Sao Paulo e de outras localidades do Pais. RESULTADOS: Desses pacientes, 26% (86/341) necessitaram de novos exames para definicao do diagnostico por encaminhamentos duvidosos, incompletos, ou devido ao periodo de espera para a realizacao dos exames e o atendimento, que variou de uma semana ate tres anos. Parte deles nao trouxe nenhum tipo de exame para essa avaliacao, 12% (45/341) retornaram para acompanhamento na propria unidade local, 13% (46/341) foram encaminhados para local de tratamento mais proximo de sua residencia, 47% (164/341) para nosso ambulatorio de subespecialidades: 24% (82/341) uremia, 8% (27/341) rins policisticos, 7% (23/341) hipertensao, 4% (16/341) litiase renal e 4% (16/341) nefrites. CONCLUSAO: Nossos resultados sugerem investimentos em infraestrutura na capacitacao dos funcionarios das UBS e do HSP, reorganizacao das centrais de referencias para melhor gerenciamento e encaminhamentos dos pacientes, humanizacao no atendimento e capacitacao dos profissionais de saude para o atendimento ambulatorial nas UBS, particularmente naqueles com diabetes mellitus e hipertensao arterial, que podem levar ao desenvolvimento da doenca renal cronica (DRC).

Avaliação do perfil epidemiológico e das dificuldades encontradas pelos pacientes para o atendimento de primeira consulta no ambulatório de triagem da nefrologia da UNIFESP

Avaliaçäo de três plantas com potencial efeito diurético

INTRODUCTION: The aim of this study was to evaluate the epidemiologic profile of patients and difficulties of patients referred by basic health units (UBS) or other hospitals, outpatient screening of the Division of Nephrology, Hospital Sao Paulo (UNIFESP) for evaluation and treatment kidney disease. METHODS: From February to September 2009, has been evaluated 341 patients referred from UBS in Sao Paulo and other parts of the Country. RESULTS: Of these patients, 26% (86/341) required for new tests to confirm the diagnosis doubtful for referrals, incomplete, or because of the waiting period for the care and exams, which ranged from one week to three years, and part of them did not bring any kind of examination for the evaluation, 12% (45/341) returned for follow-up at the unit location, 13% (46/341) were referred for treatment site closest to their residence, 47% (164/341) for our sub-specialty Clinics of Nephrology (HSP): 24% (82/341) uremia, 8% (27/341) with polycystic kidney disease, 7% (23/341) for hypertension, 4% (16/341) renal Lithiasis and 4% (16/341) nephritis. CONCLUSION: Our results suggest investments investment in infrastructure in the training of officials of UBS and HSP, reorganization of central references for better management and referral of patients, humanization of care and training of health professionals for outpatient care at UBS in preventive work and basic monitoring of patients, particularly those with diabetes mellitus and hypertension, which can lead to the development of chronic kidney disease (CKD).

Sandra Maria Rodrigues Laranja

Papers

Evaluation of acute administration of natural products with potential diuretic effects, in humans

Nephrotoxicity of low-osmolality contrast media.

Avaliação do perfil epidemiológico e das dificuldades encontradas pelos pacientes para o atendimento de primeira consulta no ambulatório de triagem da nefrologia da UNIFESP

Avaliaçäo de três plantas com potencial efeito diurético

Assessment of epidemiological profile of patients and their difficulties for the first query in the screening ambulatory of nephrology UNIFESP-EPM