The primary endpoint (HbA1c) and secondary endpoints (FBG, TC, TG, UAER, Scr, ANP, ET-1, and VEGF) in the ZSTL group were effectively improved compared with the benazepril group. progress of Chinese herbal medicine (CHM) in the treatment of DKD from two aspects. In clinical trials, the Chinese herbal formulas were efficacy and safety confirmed by the randomized Vaniprevir controlled trials. In terms of experimental research, studies provided evidence for the efficacy of CHM from the perspectives of balancing metabolic disorders, reducing inflammatory response and oxidative stress, antifibrosis, protecting renal innate cells, and regulating microRNA and metabolism. CHM consisting of different ingredients may play a role in synergistic interactions and multiple target points in the treatment of DKD. 1. Introduction Diabetic kidney disease (DKD) refers to kidney damage caused by diabetes, based on the appearance of proteinuria in diabetic patients. Clinically, the differential diagnosis of diabetic nephropathy and nondiabetic nephropathy mainly depends on the history of diabetes, screening of urinary protein, retinopathy and neuropathy, and so on. When it is difficult to diagnose, it depends on kidney biopsies. Epidemiological studies have shown that global burden of diabetes now affects more than 425 million people. If nothing is done, the number of people with diabetes worldwide will rise to 629 million in 2045 . With the prevalence in diabetes, the incidence of DKD is growing rapidly. About 30%-40% of diabetic patients develop DKD, and one third of the patients further progress to end-stage renal disease (ESRD), which brings enormous economic burden Vaniprevir for our society [2, 3]. DKD is divided into five stages according to Mogensen criteria by the course of DKD, pathological changes, the degree of proteinuria, and renal dysfunction. Persistent albuminuria and renal injury are well-established clinical signature and risk factors of renal lesions, which cause glomerulosclerosis and subsequent interstitial fibrosis . Early medical research has shown that angiotensin-converting enzyme inhibitors (ACEIs) Rabbit polyclonal to LIN28 and angiotensin II receptor blockers (ARBs), the first-line treatment for DKD, can reduce proteinuria and have a certain effect on delaying the progress of renal dysfunction . However, the side effects of ACEI/ARB, such as dry cough, hypotension, hyperkalemia, and angioedema, limit the application of these drugs. Evidence-based medical studies have shown that these agents have not significantly reduced DKD vascular event rate and mortality . Some promising therapies addressing novel targets, such as incretin-based therapies glucagon-like peptide-1 (GLP-1) receptor antagonists and dipeptidyl peptidase-4 (DPP-4) inhibitors, might improve albuminuria in type 2 diabetes, while effects on clinically relevant kidney outcomeshile effects on clinically relevant kidney outcomes are still under evaluation . Several large-scale trials focused on sodium-glucose cotransporter-2 (SGLT2) inhibitors (SGLT2i) have reported favorable effects on the primary endpoint, a composite of myocardial infarction, stroke, and cardiovascular death of people who have type 2 diabetes [8, 9]. Recently, CREDENCE clinical trials, Vaniprevir a double-blind, randomized trial, demonstrated that patents in the canagliflozin group have a lower risk of the primary composite outcome of end-stage kidney disease, doubling of the serum creatinine level or death from renal or cardiovascular causes than in the placebo group with a median follow-up of 2.62 years . However, adverse events associated with SGLT2 inhibitors include genital mycotic infections, urinary tract infection, hypoglycemia, diabetic ketoacidosis, hypotension, acute kidney injury, fractures, and amputations . It is of great urgency Vaniprevir to search for safe and effective therapies for DKD. A systematic review and meta-analysis reported that traditional Chinese medicine (TCM) had a great beneficial effect on the reduction of urinary albumin creatinine ratio Vaniprevir and proteinuria . TCM has formed a unique system to diagnose and cure illness which incorporates Chinese herbal medicine (CHM), acupuncture, moxibustion, massage (tui na), and exercise (qi gong). CHM is composed by the principle of Jun Chen Zuo Shi, which can achieve the purpose of improving efficacy and reducing toxicity. This combination of compounds is a synergistic effect rather than.