Sep 15 2010

Wormwood (Artemisia absinthium) for Poorly Responsive Early-Stage IgA Nephropathy: A Pilot Uncontrolled Trial – Corrected Proof

Background:: Inhibition of the renin-angiotensin system is a widely accepted approach to treat immunoglobulin A (IgA) nephropathy, whereas the role of fish oils as a supplement is controversial. Tumor necrosis factor α (TNF-α) is considered to be involved in the pathophysiologic process of this disorder. Recent in vitro and clinical observations that wormwood can decrease TNF-α levels has led us to investigate the effect of wormwood as a supplement in patients with IgA nephropathy.Study Design:: Pilot uncontrolled trial.Setting & Participants:: 10 patients with biopsy-proven IgA nephropathy, normal kidney function, and a history of at least 3 months of proteinuria with protein excretion >500 mg/d and <3,500 mg/d despite ongoing dual renin-angiotensin system blockade.Intervention:: The selected patients were given supplements of 1.8 g/d of thujone-free wormwood preparation for 6 months without discontinuing their renin-angiotensin system blockade.Outcomes:: Proteinuria and blood pressure after intervention compared with baseline values.Measurements:: Monthly assessment of urine protein-creatinine ratio and blood pressure during the observation period.Results:: Urine protein-creatinine ratio decreased significantly from 2,340 ± 530 to 315 ± 200 mg/g at the end of the supplementation period (P < 0.001) and was stable during the supplement-free follow-up of another 6 months. Estimated glomerular filtration rate and endogenous creatinine clearance were unchanged during the entire study period. There was a moderate, but significant, decrease (P < 0.002) in mean arterial blood pressure.Limitations:: Open uncontrolled trial including a small number of patients.Conclusions:: Thujone-free wormwood with its favorable safety profile can be an alternative supplement to manage proteinuria in patients with IgA nephropathy.

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