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| REVIEW ARTICLE |
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| Year : 2018 | Volume
: 4
| Issue : 2 | Page : 26-29 |
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Renoprotective role of turmeric in chronic kidney disease
Anita Saxena
Professor, Department of Nephrology, Sanjay Gandhi Postgraduate Institute of Medical Sciences, Lucknow, Uttar Pradesh, India
| Date of Web Publication | 6-Dec-2018 |
Correspondence Address:
 Source of Support: None, Conflict of Interest: None
DOI: 10.4103/2395-1540.247003
How to cite this article:
Saxena A. Renoprotective role of turmeric in chronic kidney disease. J Renal Nutr Metab 2018;4:26-9 |
In pathophysiological conditions, oxidative stress and inflammation are inseparable from each other. In chronic kidney disease (CKD) complex interaction of inflammation, oxidative stress, involves apoptosis and fibrosis that lead to progressive glomerular and tubulointerstitial scarring. Hasegawa et al. have shown that levels of tumor necrosis factor-α (TNFα) and interleukin-1 (IL-1) were significantly increased in glomerular basement membranes of STZ-treated diabetic rats. IL-6 expression along with increased renal cortical IL-6 mRNA is also reported. Oxidative stress promotes inflammation via toxic effects of reactive oxygen species (ROS) and by activation of redox-sensitive proinflammatory signaling pathways.
Besides driving kidney failure, inflammation and oxidative stress perpetuate atherosclerosis and vascular calcification, thus directly contributing to the elevated cardiovascular morbidity and mortality rates in CKD patients. Inflammation becomes prolonged in the form of chronic acute phase reaction and leads to adverse consequences such as decline in appetite, increased rate of protein depletion in skeletal muscle, hypercatabolism, endothelial damage and atheroclerosis.
Till now, there is no drug to improve kidney function in patients with CKD. The current therapeutic approaches to slow down its progression are limited to normalization of insulin, glucose and blood pressure. Turmeric (Curcuma longa L.) is an integral part of Asian culture and cuisine. It is a popular Asian spice that has been utilized for centuries in herbal medicines for the treatment of various diseases such as rheumatism, diabetic ulcers, anorexia, cough and sinusitis. Its health benefits include antioxidant, anti-inflammatory, antineoplastic, anti-proliferative, antimicrobial effects. anticarcinogenic, antimutagenic, anticoagulant and anti-infective effects, and consequently it is hepatoprotective and cardioprotective [Figure 1], [Figure 2], [Figure 3], [Figure 4], [Figure 5], [Figure 6]. Oral curcumin has poor bioavailability, and is well tolerated for short-term use at a dose of up to 8 g per day. | Figure 1: Plasma concentrations of IL-1b (a), IL-6 (b), TNF-a (c), cystatin C (d), adiponectin (e) and sclerostin (f) in control rats, and rats treated with adenine, or adenine plus curcumin. Curcumin treatment reduces inflammatory and oxidative biomarkers. *p < 0.05, **p < 0.001, **p < 0.0001 versus the control group. #p < 0.05, P < 0.001, P < 0.0001 versus adenine alone
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 | Figure 2: Changes of antioxidant indices catalase (a), superoxide dismutase (b), Total antioxidant capacity (c), area of positive Nrf2 staining (d), (e) glutathione reductase and reduced glutathione (f) in kidneys of rats treated with adenine and adenine and cucumin (different dose). The beneficial action of curcumin was dose dependent
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 | Figure 3: Absolute change in reflection index compared to placebo after 12 weeks of treatment
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 | Figure 4: Mean percent change in malondialdehyde levels compared to placebo after 12 weeks of treatment
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 | Figure 5: Mean percent change in nitric oxide levels compared to placebo after 12 weeks of treatment
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 | Figure 6: Mean percent change in glutathione levels compared to placebo after 12 weeks of treatment
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Several animal and human clinical trials have shown that Curcumin curcumin offers nephroprotection and is safe, efficacious and cost-effective alternative to protect kidneys against harmful factors.
Cisplatinum is a powerful antineoplastic drug that is being used in the treatment of many solid tumors, such as those of the head and neck, lung, testis, ovarian and breast cancers. Nephrotoxicity is a complication of cisplatin that necessitates dose reduction; however, the mechanism of cisplatin nephrotoxicity is complex. Cisplatin causes oxidative stress, apoptosis and inflammation and increases fibrinogen formation in renal tissue; 2–5 and in patients with acute renal failure, the symptomatic lesion is acute necrosis in the proximal tubule. Use of curcuim has shown to ameliorate adverse affects of cisplatin as shown in [Table 1] and [Table 2]. | Table 1: Effects of curcumin on serum urea and creatinine levels in rats with cisplatin-induced nephrotoxicity
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 | Table 2: Effects of curcumin on tissue malondialdehyde levels in rats with cisplatin-induced nephrotoxicity
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The serum urea and creatinine concentrations were found to be significantly increased in the cisplatin-treated rats (cisplatin, 397.14 ± 103.78 mg/dL and 4.10 ± 1.63 mg/dL vs. normal control, 45.014 ± 4.77 mg/dL and 0.23 ± 0.08 mg/dL, respectively; p50.001). However, a marked decrease in the serum urea and creatinine and MDA levels in the kidney tissues (1.40 ± 0.30 mmol/L, p50.05). were observed upon administration of the curcumin in the cisplatin-treated rats.
Human trials have shown that oral consumption of Cucumin reduces CKD or T2DM development, attenuates the urinary protein excretion, decreases inflammation, diminishes atherogenic risks, and improves vascular endothelial function. Nevertheless, despite the success and usefulness of Cucumin in clinical trials, the number of studies is still very scarce, and the effect of Cucumin treatment on the redox status or the antioxidant response activation is obscure. The study being mentioned here was conducted to evaluate the effect of the dietary supplementation with Cucumin on the redox status and Nrf2 activation in the treatment of nondiabetic or diabetic proteinuric CKD in a Mexican population. [Table 3] and [Table 4] and [Figure 3], [Figure 4], [Figure 5], [Figure 6] show effect of treatment with curcumin on endothelial function. | Table 3: Effect of treatments on endothelial function and biomarkers of oxidative stress
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 | Table 4: Changes in lipid profile after 12 weeks treatment with placebo and polyherbal (cardipro)
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| Conclusion | |  |
The use curcumin in nephroprotection may offer a safe, efficacious and cost-effective, alternative to protect kidneys against harmful factors. Curcumin might avert the progression of renal impairment to the stage of CKD, end-stage renal disease (ESRD) or cardiovascular disease, where either dialysis or transplantation is the only means of therapy.
[Figure 1], [Figure 2], [Figure 3], [Figure 4], [Figure 5], [Figure 6]
[Table 1], [Table 2], [Table 3], [Table 4]
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