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Introduction Chronic Kidney Disease (CKD) still described as one of the leading public health issues globally

[1], and it is characterized by progressive loss of kidney function [2]. The nature of CKD is complex and progression will lead to the End-Stage Renal Disease (ESRD) which is critical in management [3]. In addition, CKD is often asymptomatic until the disease reaches advanced stages; also patients in that stage already have one or more disease complications [4]. Therefore, it is critical to implement a measurable successful strategy that can be taken for prevention and management of the disease before the progression to ESRD.

Until now, there are no specific therapies to treat CKD. Treatments used are mainly dialysis or kidney transplantation, and are used for symptomatic and replacing kidney function [5]. Consequently, they must be done routinely, costly, and are not dissolve the problem. Therefore, alternative therapies are used to inhibit the progression of CKD; provide several effective therapeutic approaches to address the diverse pathologic conditions related to CKD, as it safe and not expensive [4.5].

Traditional and alternative medications comprise a variety of therapeutic approaches, including food habits and the use of herbs and minerals; additionally it may vary among countries [6]. These approaches based on medicinal plants to forestall the need for hemodialysis, to reduce the adverse consequences of dialysis treatments [7], and to beneficially relieve some of the associated symptoms of CKD comorbidities; such as muscle cramps, fatigue, depression and uremic bruising [4]. The diuretic properties of these herbal medicines are useful for patients on hemodialysis and for pre-dialysis patients by stimulating their kidney function and delaying the need for dialysis [8].

The most common mechanism for herbal treatment is antioxidant defense system, as they are rich sources of antioxidants [4]. Also, oxidative stress is the causative factor for a CKD

The Effect of Selected Traditional Herbal Combination with Royal Jelly on Kidney Function: Case Series

OPEN ACCESS

*Correspondence:Buthaina Alkhatib, Department of

Clinical Nutrition and Dietetics, Philadelphia University, Jarash

Road, 20 KM out of Amman, P.O. Box: 1 Amman 19392, Jordan, Tel:

+96264799000;E-mail: bkhatib@philadelphia.edu.jo

Received Date: 06 Aug 2021Accepted Date: 26 Aug 2021

Published Date: 03 Sep 2021

Citation: Alkhatib B, Alhilo I, Alhilo S. The

Effect of Selected Traditional Herbal Combination with Royal Jelly on

Kidney Function: Case Series. Ann Clin Case Rep. 2021; 6: 1981.

ISSN: 2474-1655Copyright © 2021 Buthaina

Alkhatib. This is an open access article distributed under the Creative Commons Attribution License, which permits unrestricted use, distribution,

and reproduction in any medium, provided the original work is properly

cited.

Research ArticlePublished: 03 Sep, 2021

AbstractAim: This retrospective case study was conducted to investigate the effect of using a herbal mixture herbal mixture (which is composed of corn silk (Stigma maydis), Paronychia arabica (paronychia), Frankincense (Gum olibanum) and Asparagus racemosus roots (shatavari)) accompanied with Royal Jelly capsules on renal function assessed by serum creatinine level.

Methodology: This study was conducted by reference to computer patients' files between 2015 and 2018 in Herbal Dynasty Medical Center, Amman, Jordan. A 20 cases of renal failure patients of both sexes (9 females’ and 11 males) (age range 23 to 71 years) were selected. Serum creatinine before and after the treatment were reported. Also, estimated Glomerular Filtration Rates (eGFR) were calculated.

Results: Mean serum creatinine levels after herbal treatment for all selected cases were decreased by (2.8 ± 1.4) as compared to mean serum creatinine levels before the treatment (3.9 ± 1.8). The majority of patients have been transmitted from advanced stages of CKD to lower stages based on eGFR.

Conclusion: The use of herbal and alternative therapies in CKD lead to a decrease of serum creatinine levels and to transition patients from advanced stages to another lower; which means that treatments enhance kidney function and decrease deterioration.

Keywords: Kidney function; Corn silk; Shatavari root; Boswellia; Gum olibanum; Royal jelly

Buthaina Alkhatib1*, Iman Alhilo2 and Samir Alhilo3

1Department of Clinical Nutrition and Dietetics, Philadelphia University, Jordan

2Mutah University, Herbal Dynasty Medical Center, Jordan

3The University of Jordan, Herbal Dynasty Medical Center, Jordan

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Buthaina Alkhatib, et al.,

[9]. Furthermore, herbs have anti-inflammatory effects [10], diuresis, immunomodulation, reduction in proteinuria and stimulation of renal repair mechanisms in CKD patients [11]. In the Middle East, many herbs were used to manage kidney diseases; specially kidney function, stones and inflammation such as corn silk (Zea mays L. Hair), Paronychia arabica (paronychia), Frankincense (Gum olibanum), Asparagus racemosus roots and Royal Jelly.

Corn silk (Stigma maydisor Zea mays L. Hair) has been used for a long time as a treatment remedy for several illnesses and is vital as an alternative natural-based therapy [12]. It has been used as a traditional medicine in China, Turkey, United States and France [13]. Also, it has been used for the treatment of various Genito-urinary problems such as cystitis, edema, kidney stones, diuretic, prostate disorder and urinary infections [12,14]. It soothes and relaxes the bladder and urinary tubules, hence increasing urine secretion and reducing irritation [14].

The Boswellia species (Frankincense) are trees located in India, Ethiopia, Somalia, and the Arabian Peninsula, and they produce a gum better resin called Olibanum, which possesses anti-inflammatory, anti-arthritic, and analgesic properties [15,16]. Boswellic acids are the major constituents on the Olibanum gum resin and there have anti-cancer and anti-ulcerous activities [16]. Also, Rao et al. found that Boswel liaserrata has a protective effect against long-term diabetic complications specially kidney failure [15].

In addition, Gum olibanum has been used in Arabic medicine for acute renal failure and normalizes systolic and diastolic BP and heart rate. Moreover, it protects against renal failure progression, involves in antioxidant and/or anti-inflammatory activity, and it is using in drinking water normalizes plasma concentrations of urea and creatinine [17].

Furthermore, Asparagaceae family that has been known as an antioxidant, reducer blood lipid, anti-diabetic, antifungal, anti-hypertension and anti-carcinogenic medication in traditional medicine [18]. Also, Asparagus may be effective to maintain renal normal function in diabetic patients [19]. The root of Asparagus officinalis is more diuretic than its shoot and it helps flush out the kidneys and help in the prevention of the formation of kidney stones [20]. Asparagus racemosus root extract has a protective effect in renal injury in rats [21].

Royal Jelly (RJ) is also considered to have anti-inflammatory effects due to its possible antiradical and ant oxidative effects. It can have positive effects on both the prevention of urolithiasis and possible inflammation during the existing urolithiasis and support the medical treatment [10]. RJ may be used in combination with cisplatin in chemotherapy to decrease cisplatin-induced oxidative stress parameters and decrease the injury of kidneys and liver [22]. Also, pretreatment with RJ significantly reduced blood urea nitrogen, kidney malondi-aldehyde, creatinine, glomerular diameter and leukocyte infiltration [23], and it may be effective to protect the kidney against I/R injury [24].

This study was conducted to investigate the effect of the treatment of a herbal mixture (which is composed of corn silk (Stigma maydis), Paronychia arabica (paronychia), Frankincense (Gum olibanum) and Asparagus racemosus roots (shatavari)) accompanied with Royal Jelly capsules on renal function assessed by serum creatinine level.

Cases InterpretationThis retrospective case series study was conducted by reference

to computer patients' files between 2015 and 2018 in Herbal Dynasty Medical Center, Amman, Jordan. A 20 cases of renal failure patients of both sexes (9 females’ and 11 males) (age range 23 to 71 years) were selected. Serum creatinine before and after the treatment were reported. The consent of all patients attending the center is taken to use their medical results in scientific research. The study has been approved by Department of Clinical Nutrition and Dietetics Faculty of Science Philadelphia University, Amman, Jordan.

The selected treatment was traditional herbal mixture produced as tea bags (Approved by FDA Jordan). It was composed of corn silk (Stigma maydis); Paronychia Arabica (paronychia), Frankincense (Gum olibanum) and Asparagus racemosus roots (Shatavari) in equal amounts, each bag contains 3 g of herbal mixture. Herbal mixture was prescribed for patients by physicians with a specific dose of two tea bags daily soaking in a 150 ml cup of boiling water for 10 min, half an hour before meals, with a RJ capsules (one capsule 1000 mg daily before half an hour before meal) for 2 months. Patients were recommended to complete life-long treatment to be more comprehensive and creatinine to be normal.

Patients came to the clinic trying to avoid reaching the hemodialysis phase, and were followed up every two weeks; changes in creatinine levels were monitored. Under the supervision of doctors at the center. Moreover, an important recommendation was made during the treatment period regarding the diet; based on National Institute of Health (NIH): NIDDK (2014).

After the two-month deadline expires, patients whose kidneys function was not improved and there was no or bad response to the treatment, they were given the choice to continue the treatment or return to a nephrologist and start dialysis.

Data were analyzed using Microsoft office Excel (Windows 10). Means ± SD were calculated. Estimated Glomerular Filtration Rate (eGFR) was calculated based on the following formula: eGFR=186 × (Creatinine/88.4)-1.154 × (Age)-0.203 × (0.742 if female) × (1.210 if black). Then, patients were classifieds to different stages of renal failure (before and after) with reference to National Kidney Foundation, as followed: stage 1 CKD: eGFR 90 or Greater; stage 2 CKD: eGFR between 60 and 89; stage 3A CKD: eGFR between45 and 59; stage 3B CKD: eGFR between 30 and 44; stage 4 CKD: eGFR between 15 and 29 and stage 5 CKD: eGFR Less than 15.

Results and Discussion The mean age of the selected sample was 52.8 years as shown in

Table 1. Serum creatinine levels after herbal treatment for all selected cases were decreased by (2.8 ± 1.4) as compared to creatinine levels before the treatment (3.9 ± 1.8). The mean decrease of creatinine levels for all cases was 1.1 ± 0.9 (Table 1).

As shown in Table 2, 14 from 20 of participants were transitioned from advanced stage to another lower based on eGFR.

Due to the lack of treatment in conventional medical system for CKD, many patients turn to the complementary and alternative medicine, to help manage their disease and prevent disease deterioration. Several herbals and alternative choices have been used worldwide. In Arab region they are using curcumin, black seed, Royal Jelly, corn silk (Stigma maydis), Paronychia Arabica (paronychia), Frankincense (Gum olibanum) and Asparagus racemosus roots (Shatavari).

Current study reported that selected herbal mixture accompanied

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Buthaina Alkhatib, et al.,

with Royal Jelly lead to an efficient decrease of serum creatinine levels in renal failure patients, and it may protect kidneys and enhance their function. However, the literature provides evidence for the role of natural whole products rather than single antioxidants or their combinations in preventing or managing kidney diseases [9].

In line with the current findings, several studies approved the role of RJ in protecting kidneys, decrease injury, decrease oxidative stress and decrease creatinine levels [22-24]. Additionally, many herbs were used alone or in combination with other herbs as alternative solution for CKD, including the herbal mixture that was used in the current study. In details, Corn silk (Stigma maydis or Zea mays L. Hair) has been used for the treatment of various Genito-urinary problems such as cystitis, edema, kidney stones, diuretic, prostate disorder and urinary infections [12,14]. Also, it has been found to sooth and relax the bladder and urinary tubules, increasing urine secretion and reducing irritation [14]. While the Boswellia species (Frankincense) possesses anti-inflammatory, anti-arthritic, anti-cancer and analgesic properties [15,16], Rao et al. found that Boswel liaserrata has a protective effect against kidney failure [15].

Moreover, Ali et al. found that Gum olibanum has protected kidneys against renal failure progression, involved in antioxidant and/or anti-inflammatory activity, and it normalized plasma concentrations of urea and creatinine [17]. Dehghan-Shahrezaand et al. approved that Asparagus may be effective to maintain renal normal function in diabetic patients [19]. Also, the root of Asparagus officinalis/or racemosus was proved as diuretic and it help flushing out the kidneys and in the prevention of kidney stones formation, additionally it has a protective effect in renal injury in rats [20,21].

ConclusionThe use of herbal and alternative therapies in CKD leads to

a good result. It decreases serum creatinine levels; which means that treatments have enhances kidney functions and decrease deterioration. Original-longitudinal studies are warranted to approve the role of single or combination of herbal/alternative therapies on CKD.

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Cases Sex Age (years)Serum

Creatinine before(mg/dL)

Serum Creatinine

after (mg/dL)

The decrease of creatinine

level1 F 57 3.5 1.3 2.2

2 F 58 2.8 1.8 1.0

3 F 62 4.2 3.1 1.1

4 F 49 4.8 1.7 3.1

5 F 23 6.9 5.2 1.7

6 F 60 3.8 3.2 0.6

7 F 42 2.3 1.9 0.4

8 F 47 6.4 4.5 1.9

9 F 56 1.7 1.3 0.4

10 M 71 7.0 4.0 3.0

11 M 47 3.2 2.9 0.3

12 M 50 1.4 1.0 0.4

13 M 40 6.3 6.0 0.3

14 M 53 6.4 4.0 2.4

15 M 55 1.5 1.2 0.3

16 M 52 3.8 2.3 1.5

17 M 63 4.1 3.4 0.7

18 M 42 3.8 3.6 0.2

19 M 62 1.8 1.5 0.3

20 M 67 3.0 2.2 0.8

Mean ± SD 52.8 ± 11.0 3.9 ± 1.8 2.8 ± 1.4 1.1 ± 0.9

Table 1: The change in serum creatinine levels before/after herbal treatment accompanied with Royal Jelly.

M: Male; F: Female; SD: Standard Deviation

Cases Sex Age (years)

GFR before the treatment (ml/

min/m2)

GFR after the treatment (ml/

min/m2)

CKD stage changes

1 F 57 14 45 5 to 3A

2 F 58 18 31 4 to 3B

3 F 62 11 16 5 to 4

4 F 49 10 34 5 to 3B

5 F 23 8 11 5 to 5

6 F 60 13 16 5 to 4

7 F 42 25 31 4 to 3B

8 F 47 7 11 5 to 5

9 F 56 33 45 3B to 3A

10 M 71 8 16 5 to 4

11 M 47 22 25 4 to 4

12 M 50 57 84 3A to 2

13 M 40 11 11 5 to 5

14 M 53 10 17 5 to 4

15 M 55 52 67 3A to 2

16 M 52 18 32 4 to 3B

17 M 63 16 20 4 to 4

18 M 42 19 20 4 to 4

19 M 62 41 50 3B to 3A

20 M 67 22 32 4 to 3B

Table 2: The change in eGFR and CKD classification before/after alternative treatment.

M: Male; F: Female; SD: Standard Deviation, eGFR: Glomerular Filtration Rate; CKD: Chronic Kidney Disease

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