How to potentialize the effect of renin-angiotensin-aldosterone system inhibitors?

Main Article Content

D.D. Ivanov


The scientific review presents a practical analysis of the properties of Lespedeza capitata in terms of its attractiveness for nephrological practice. Lespedeza shows many effects on ectoderm derivatives, including skin and the kidneys. Thus, the results of studies showed significant stimulation of the growth of fibroblasts and keratinocytes, as well as increased collagen synthesis with a lipolytic effect on adipocytes. The researchers concluded the possibility of using herbal medicinal preparations of Lespedeza capitata to stimulate skin cells and tissue regeneration, for anti-aging therapy and induction of lipolysis due to flavonoid extract. Lespedeza capitata extract enhances diuresis, eliminates edema, reduces azotaemia and albuminuria, increases sodium excretion, and to lesser extent potassium, promotes renal filtration and excretion of nitrogenous products in the urine. The advantages of phytotherapy in normalizing the capillary permeability of the glomeruli are a mild diuretic effect, which prevents a significant loss of electrolytes in contrast to synthetic diuretics. These effects are now considered as potentiating the action of inhibitors of the renin-angiotensin system, which is the basis of renoprotection in modern nephrology. Lespedeza flavonoids improve protein-energy metabolism, which has been demonstrated in many models of acute renal failure. Correction of protein metabolism has a favourable nephroprotective effect and slows the progression of chronic kidney disease (CKD) while maintaining normal excretory function. Lespedeza extract can be considered as a substance that enhances the action of renin-angiotensin-aldosterone system inhibitors (RAASi), acting synergistically in inhibiting the activity of the renin-angiotensin system. This property of the drug becomes very relevant in patients with CKD stage 5 when the abolition of RAASi today corresponds to the current trend. Maintaining a small dose of RAASi in stage 10 CKD, or the use of RAASi with extrarenal elimination in combination with Lespedeza extract demonstrates encouraging results in clinical practice.

Article Details

How to Cite
Ivanov, D. “How to Potentialize the Effect of Renin-Angiotensin-Aldosterone System Inhibitors?”. KIDNEYS, vol. 10, no. 3, Sept. 2021, pp. 156-61, doi:10.22141/2307-1257.10.3.2021.239593.
Original Articles


United States Department of Agriculture(USDA); Natural Resources Conservation Service (NRCS). Kanoka roundhead lespedeza (Lespedeza capitata): Release Brochure. Manhattan, KS: Manhattan Plant Materials Center; 2011. 2 p.

Barbosa-Filho J, Martins VKM, Rabelo LA, et al. Natural products inhibitors of the angiotensin converting enzyme (ACE): a review between 1980-2000. Rev Bras Farmacogn. 2006;16(3):421-446. doi:10.1590/S0102-695X2006000300021.

Yarnell EL. Botanical medicines used for kidney disease in the United States. Iran J Kidney Dis. 2012 Nov;6(6):407-418.

Gwaltney-Brant ShM. Chapter 8 - Nutraceuticals in renal diseases. In: Gupta RE, editor. Nutraceuticals: Efficacy, Safety and Toxicity. San Diego: Academic Press; 2016. 101-108 pp. doi:10.1016/B978-0-12-802147-7.00008-5.

Whittington HR, Deede L, Powers JS. Growth responses, biomass partitioning, and nitrogen isotopes of prairie legumes in response to elevated temperature and varying nitrogen source in a growth chamber experiment. Am J Bot. 2012 May;99(5):838-846. doi:10.3732/ajb.1100283.

Bakker MG, Schlatter DC, Otto-Hanson L, Kinkel LL. Diffuse symbioses: roles of plant-plant, plant-microbe and microbe-microbe interactions in structuring the soil microbiome. Mol Ecol. 2014 Mar;23(6):1571-1583. doi:10.1111/mec.12571.

Bakker MG, Bradeen JM, Kinkel LL. Effects of plant host species and plant community richness on streptomycete community structure. FEMS Microbiol Ecol. 2013 Mar;83(3):596-606. doi:10.1111/1574-6941.12017.

United States Department of Agriculture (USDA); Natural Resources Conservation Service (NRCS). Plants Database: Plant List of Accepted Nomenclature, Taxonomy and Symbols. Available from:

National Agency for the Safety of Medicines and Health Products (ANSM). The French Pharmacopoeia. Saint-Denis: ANSM; 2012. (in French).

Torloni L, Facó L, Magaton E, Eberlin S, Alves Tabarini Pinheiro AL. 16311 Protective effects of an active complex against unbalanced biomarkers induced by infrared-A radiation, blue light, and heavy metals: An integral approach of skin aging. JAAD. 2020;83(Suppl 6):AB175. doi:10.1016/j.jaad.2020.06.790.

Pastorino G, Borghesi B, Burlando B, Marchetti C, Cornara L, Ribulla S. Biological activities of the legume crops Melilotus officinalis and Lespedeza capitata for skin care and pharmaceutical applications. Industrial Crops and Products. 2017;96:158-164. doi:10.1016/j.indcrop.2016.11.047.

Yeom M, Lee H, Shin S, Park D, Jung E. PER, a Circadian Clock Component, Mediates the Suppression of MMP-1 Expression in HaCaT Keratinocytes by cAMP. Molecules. 2018 Mar 23;23(4):745. doi:10.3390/molecules23040745.

Sami U. Methanolic extract from Lespedeza bicolor: potential candidates for natural antioxidant and anticancer agent. J Tradit Chin Med. 2017 Aug;37(4):444-451.

Roydhouse JK, Menapace LA, Xia H, et al. Concomitant botanical medicine use among patients participating in commercial prostate cancer trials. Complement Ther Med. 2020 Nov;54:102549. doi:10.1016/j.ctim.2020.102549.

Gwaltney-Brant ShM. Chapter 9 - Nutraceuticals in renal diseases. In: Gupta RC, Lall R, Srivastava A, editors. Nutraceuticals: Efficacy, Safety and Toxicity. 2nd ed. San Diego: Academic Press; 2021. 131-139 pp. doi:10.1016/B978-0-12-821038-3.00008-2.

Do MH, Lee JH, Wahedi HM, et al. Lespedeza bicolor ameliorates endothelial dysfunction induced by methylglyoxal glucotoxicity. Phytomedicine. 2017 Dec 1;36:26-36. doi:10.1016/j.phymed.2017.09.005.

Rask-Madsen C, King GL. Vascular complications of diabetes: mechanisms of injury and protective factors. Cell Metab. 2013 Jan 8;17(1):20-33. doi:10.1016/j.cmet.2012.11.012.

Lee JK, Kang DG, Lee HS. Vascular relaxation induced by aqueous extract of Lespedeza cuneata via the NO-cGMP pathway. J Nat Med. 2012 Jan;66(1):17-24. doi:10.1007/s11418-011-0546-6.

Shtrygol SYu, Tovchiga OV. Biologically active substances and drugs of herbal origin with nephroprotective effect. Farmacom. 2010;(1):140-156. (in Russian).

Tovchiga OV, Rolik SM, Shtrygol SYu. Nephroprotective preparations: the review of the ukrainian pharmaceutical market. Ukrainian biopharmaceutical journal. 2011;(13):29-36. (in Ukrainian).

Shebeko SK, Zupanets IA, Shalamay AS. The study of the influence of Glucuamine on the course of glomerulonephritis with renal failure in the experiment. Pharmacology and Drug Toxicology. 2017;(56):66-71. (in Ukrainian).

Wagner H, Elbl G. ACE-inhibitory procyanidins from Lespedeza capitata. Planta Med. 1992 Jun;58(3):297. doi:10.1055/s-2006-961466.

Cornara L, Xiao J, Burlando B. Therapeutic Potential of Temperate Forage Legumes: A Review. Crit Rev Food Sci Nutr. 2016 Jul 29;56(Suppl 1):S149-61. doi:10.1080/10408398.2015.1038378.

Iakovleva EV. Zabolevaniia pochek v praktike uchastkovogo terapevta: uchebno-metodicheskoe posobie [Kidney disease in the practice of the local therapist: teaching aid]. Minsk: BGMU; 2010. 52 p. (in Russian).

Fan X, Wei W, Huang J, Liu X, Ci X. Isoorientin Attenuates Cisplatin-Induced Nephrotoxicity Through the Inhibition of Oxidative Stress and Apoptosis via Activating the SIRT1/SIRT6/Nrf-2 Pathway. Front Pharmacol. 2020 Mar 18;11:264. doi:10.3389/fphar.2020.00264.

Popova SI, Dikhtyarev SI, Maslova NF, Litvinenko VI, Almakaeva LG. Healing of kidney diseases with herbal drugs. Fi toterapia. 2011;(4):40-44. (in Russian).

Tovchiga OV, Shtrygol SYu. Effect of medicinal plants on the excretory renal function (a review). Eksperimentalnaya i klinicheskaya farmakologiya. 2009;72(3):50-59. doi:10.30906/0869-2092-2009-72-3-50-59. (in Russian).

Libera: instructions for the drug. Available from:

Libera: instructions for the drug. Available from:

Most read articles by the same author(s)

1 2 3 4 5 6 7 8 9 10 > >>