Original Investigation
Pathogenesis and Treatment of Kidney Disease
Wormwood (Artemisia absinthium) for Poorly Responsive Early-Stage IgA Nephropathy: A Pilot Uncontrolled Trial

https://doi.org/10.1053/j.ajkd.2010.06.025Get rights and content

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.

Section snippets

Methods

We enrolled patients of either sex with biopsy-proven IgA nephropathy who were aged 18-35 years with persistent proteinuria with protein excretion >500 and <3,500 mg/d in the previous 3 months or longer despite dual RAS inhibition and excluded those with exposure to steroids before the study. We selected patients who had undergone kidney biopsy not more than 2 years before the study, with normal kidney function (serum creatinine <1.5 mg/dL, creatinine clearance >90 mL/min, and estimated

Results

We recruited 4 women and 6 men aged 19-33 years (mean, 26.4 ± 4.4 years) with body mass index of 18-27 kg/m2 (mean, 22.4 ± 3.3 kg/m2) and plasma creatinine level of 0.7-1.3 mg/dL (mean, 1.11 ± 0.25 mg/dL). All had previously received a trial of fish oil without success with respect to proteinuria decrease. Data for the time of discontinuation of fish oil therapy in individual patients were not available. No patient had received steroids before study entry. Because of well-preserved kidney

Discussion

At present, the most powerful prognostic factor in IgA nephropathy is the level and duration of proteinuria. The longer and higher the proteinuria, the worse the prognosis.1 To avoid end-stage renal disease, in addition to rigorous control of blood pressure, a decrease in proteinuria is critical. Apparently these goals can be met using wormwood supplementation without undue side effects in patients for whom dual ACE-inhibition and ARB therapy is working poorly. We also observed significant

Acknowledgements

Support: Wormwood (Seda-Leukin) capsules were a generous gift from Noorherbals.

Financial Disclosure: Aside from that reported in the previous section, the authors declare that they have no relevant financial interests.

References (19)

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Cited by (16)

  • Americans' use of dietary supplements that are potentially harmful in CKD

    2013, American Journal of Kidney Diseases
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    Similarly, we acknowledge that some herbs included in the NKF list may have potential benefits. Senna, for example, is widely prescribed for constipation and a recent uncontrolled pilot trial found that wormwood significantly decreased proteinuria in 10 patients with immunoglobulin A nephropathy.37 However, given the lack of consistency between products,26,38 the lack of rigorous safety or efficacy testing, and the tendency for patients to believe people are rarely or never harmed by supplements,21 it is important to raise awareness of potential harm.

  • An update on the pathogenesis and treatment of IgA nephropathy

    2012, Kidney International
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    Sirolimus has been shown to reduce proliferative glomerular lesions at 12 months, compared with the standard therapy using an ACEi and statin.94 Wormwood (Artemisia absinthium), which reduces renal tumor necrosis factor-α levels, has been shown to reduce proteinuria significantly in patients with uncontrolled proteinuria despite dual renin–angiotensin system blockade.95 The achieved reduction of proteinuria was sustained over 6 months of treatment, and persisted over a further 6 months after the supplement was withdrawn.

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Originally published online as doi:10.1053/j.ajkd.2010.06.025 on September 15, 2010.

Trial registration: www.isrctn.org; study number: NCT01126931.

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