BACKGROUND Proliferative lupus nephritis(PLN)is the most severe form of lupus nephritis(LN).There are limited data available on renal outcomes of PLN from developing countries.AIM To determine the clinicopathological ...BACKGROUND Proliferative lupus nephritis(PLN)is the most severe form of lupus nephritis(LN).There are limited data available on renal outcomes of PLN from developing countries.AIM To determine the clinicopathological characteristics and long-term outcomes in terms of remission,requirement of kidney replacement therapy(KRT),and patient survival.METHODS A retrospective analysis was conducted on biopsy-proven focal or diffuse PLN cases diagnosed between 1998 and 2019 at the Sindh Institute of Urology and Transplantation and followed up at the renal clinic for a minimum of 5 years.All patients were induced with a combination of intravenous cyclophosphamide and corticosteroids for 6 months,followed by maintenance treatment with azathioprine(AZA)or mycophenolate mofetil(MMF).Data were analyzed using Statistical Package for the Social Sciences,version 22.0.P≤0.05 was considered statistically significant.RESULTS The mean age at the onset of systemic lupus erythematosus was 24.12 years±8.89 years,and at LN onset,26.63 years±8.61 years.There was a female predominance of 184(88.9%)cases.Among baseline characteristics,reduced estimated glomerular filtration rate,presence of hypertension,requirement of KRT,and underlying renal histology(International Society of Nephrology/Renal Pathology Society class IV than class III)were significantly associated with end-stage kidney disease(ESKD)and mortality.The renal outcomes were negatively correlated with age,duration of symptoms,and 24-hour urinary protein excretion.The overall remission rate was 89.8%at the end of induction therapy.At 5 years,141(68.11%)patients were in complete and partial remission(94[45.4%]and 47[22.7%],respectively).In total,19(9.2%)patients required KRT on presentation,and at 5 years,38(18.4%)patients developed ESKD,and 28(13.5%)patients died.Thirty-four(16.4%)patients had a renal relapse,more with AZA than MMF(30[88.2%]vs 4[11.76%],respectively;P=0.04).Renal survival at 6 months was 89.8%,while at 5 years,it was 68.11%,showing a significant improvement in patients who did not need KRT at the time of presentation(P<0.0001).CONCLUSION Baseline renal functions,requirement of KRT,and diffuse proliferative disease were the most relevant prognostic factors for kidney survival among this cohort.Short-term renal outcomes were good.Long-term outcomes were poorer with AZA-based maintenance therapy than with MMF,with more ESKD and mortality.展开更多
Objective To review and synthesize preclinical and clinical evidence regarding traditional Chinese medicine(TCM)formulations and bioactive herbal compounds in lupus nephritis(LN),and to identify direction and research...Objective To review and synthesize preclinical and clinical evidence regarding traditional Chinese medicine(TCM)formulations and bioactive herbal compounds in lupus nephritis(LN),and to identify direction and research priorities for integrating TCM with professional care.Methods A narrative literature review was conducted by searching Scopus,PubMed,Web of Science,and Google Scholar for articles published between January 1,2011 and March 31,2024.Search terms combined controlled vocabulary[e.g.,medical subject headings(MeSH)]and free-text words including lupus nephritis,traditional Chinese medicine,Chinese herbal medicine,formulation,and names of specific herbs[Leigongteng(Tripterygii Wilfordii Radix et Rhizoma),Baishao(Paeoniae Radix Alba),and Yinghao(Artemisiae Annuae Herba)].Both randomized controlled trials and observational studies were included,along with mechanistic preclinical studies and pharmacologic investigations.Inclusion criteria were studies that reported renal outcomes(proteinuria and estimated glomerular filtration rate),immunemodulatory mechanisms,or safety and herb-drug interaction data.Studies without primary data,case reports,or those lacking relevance to LN were excluded.References of key articles were manually screened to identify additional eligible studies.Results TCM formulas[e.g.,Liuwei Dihuang Pills(六味地黄丸),Zhibai Dihuang Pills(知柏地黄丸),and Huanglian Jiedu Decoction(黄连解毒汤)]and herbal medicines[e.g.,extracts from Leigongteng(Tripterygii Wilfordii Radix et Rhizoma),Baishao(Paeoniae Radix Alba),and Yinghao(Artemisiae Annuae Herba)]were commonly used in the above studies.TCM formulations and their constituent compounds showed multi-modal mechanisms relevant to LN pathogenesis,encompassing immunomodulation(reduction of autoreactive B/T cell activity,regulatory T cell enhancement),inhibition of pro-inflammatory signaling pathways nuclear factor kappa-light-chain-enhancer of activated B cells(NF-κB),mitogen-activated protein kinase(MAPK),nucleotide-binding oligomerization domain(NOD),leucine-rich repeat(LRR)and pyrin domain-containing protein 3(NLRP3 inflammasome),anti-fibrotic and antioxidant effects,and direct renal-protective properties.In many studies,these indicators can reduce proteinuria and improve renal function.Clinical data,while promising,are heterogeneous in design,sample size,endpoints,and TCM formulation standardization.Safety concerns(notably with Tripterygium preparations)and potential herb-drug interactions with immunosuppressants remained important considerations.Conclusion TCM offers biologically plausible and multi-targeted adjuvant strategies for LN that may enhance therapeutic efficacy and reduce toxicity when combined with modern therapies.To translate these promises into clinical practice,future work should prioritize the standardization of TCM preparations,randomized controlled trials with clinically meaningful renal endpoints,elucidation of molecular mechanisms,and systematic evaluation of pharmacokinetic and safety interactions.Such integrative research will be essential to define the TCM’s role in evidence-based,patient-centered LN management.展开更多
Objective To clarify the causal relationship between the level of cytoplasmic unactivated mineralocorticoid receptor(MR)and the development of tubulointerstitial nephritis(TIN),and to evaluate the impact of MR on dysl...Objective To clarify the causal relationship between the level of cytoplasmic unactivated mineralocorticoid receptor(MR)and the development of tubulointerstitial nephritis(TIN),and to evaluate the impact of MR on dyslipidemia,particularly secondary hyperlipemia,in patients with diabetic kidney disease.Methods We conducted a two-sample Mendelian randomization study using genome-wide association study(GWAS)summary data.Genetic variants associated with MR levels were selected as exposures,with TIN and lipid profiles[including low-density lipoprotein cholesterol(LDL-C),triglyceride,and high-density lipoprotein cholesterol]as outcomes.A two-step Mendelian randomization approach was used to assess TIN as a mediator,employing inverse variance weighted regression as the primary analysis,supplemented by Mendelian randomization-Egger,weighted median,and sensitivity analyses.Results Cytoplasmic unactivated MR level exhibited a significant causal association with a decreased risk of TIN(OR=0.8598,95%CI[0.7775-0.9508],P<0.001).Although no significant causal relationship was identified between MR level and secondary hyperlipemia,a potential association of cytoplasmic unactivated MR level with lower LDL-C levels was observed(OR=0.9901,95%CI[0.9821-0.9983],P=0.018).Additionally,TIN exhibited causal links with secondary hyperlipemia(OR=1.0016,95%CI[1.0002-1.0029],P=0.020)and elevated LDL-C(OR=1.0111,95%CI[1.0024-1.0199],P=0.012),particularly LDL-C in European males(OR=1.0230,95%CI[1.0103-1.0358],P<0.001).Inverse Mendelian randomization analysis revealed causal relationships between TIN and genetically predicted triglyceride(OR=0.7027,95%CI[0.6189-0.7978],P<0.001),high-density lipoprotein cholesterol(OR=1.1247,95%CI[1.0019-1.2626],P=0.046),and LDL-C(OR=0.8423,95%CI[0.7220-0.9827],P=0.029).Notably,TIN mediated 16.7%of the causal association between MR and LDL-C levels.Conclusions MR plays a critical role in the development of TIN and lipid metabolism,highlighting the potential of MR-antagonists in reducing renal damage and lipid metabolism-associated complications.展开更多
Pediatric lupus nephritis(LN)is a challenging and severe condition in pediatrics.Traditional Chinese medicine(TCM)has shown significant advantages in improving immune disorders,reducing recurrence rates,and mitigating...Pediatric lupus nephritis(LN)is a challenging and severe condition in pediatrics.Traditional Chinese medicine(TCM)has shown significant advantages in improving immune disorders,reducing recurrence rates,and mitigating the toxic side effects of Western medications.However,it faces challenges such as the lack of a unified TCM syndrome differentiation system,insufficient standardization of dynamic syndrome differentiation,an incomplete efficacy evaluation system,and a lack of precise intervention methods.This study focuses on the clinical advantages of TCM.On 1 September 2024,the 35th Clinical Advantage Disease Series Salon was held in Zhengzhou,discussing the advantages of TCM and integrated Chinese-Western medicine in treating pediatric LN.Experts in TCM and integrated Chinese-Western medicine,along with interdisciplinary researchers,conducted extensive and in-depth discussions.They proposed specific recommendations for TCM and integrated Chinese-Western medicine in treating pediatric LN and reached a consensus.Based on this,the study analyzes the challenges in treating pediatric LN from the perspective of its development patterns,and summarizes three key areas and six research directions to highlight the advantages of TCM and integrated Chinese-Western medicine in treating pediatric LN.It focuses on three key areas:The construction of a TCM system for pediatric LN,the prevention and treatment of complications,and chronic disease management.And it proposes six research directions:(1)Constructing a syndrome differentiation system for pediatric LN;(2)Formulating TCM and integrated Chinese-Western medicine guidelines for pediatric LN;(3)Researching the mechanisms of enhancing efficacy and reducing toxicity in integrated Chinese-Western medicine for pediatric LN;(4)Preventing and treating complications in pediatric LN;(5)Developing and researching TCM regimens for preventing and treating the recurrence of pediatric LN;(6)Strategies for the full-cycle chronic disease management of pediatric LN.Finally,the study summarizes and generalizes the technological layout and research directions for pediatric LN.Therefore,based on the series of salons on traditional Chinese medicine advantages for children LN diseases,this paper puts forward a research paradigm of scientific and technological breakthroughs for children LN,in order to provide reference for the construction and research direction of children LN diagnosis and treatment system with traditional Chinese medicine characteristics.展开更多
Lupus nephritis(LN)is one of the most common and serious complications of systemic lupus erythematosus,which can lead to end-stage renal disease,and is an important cause of death in patients with systemic lupus eryth...Lupus nephritis(LN)is one of the most common and serious complications of systemic lupus erythematosus,which can lead to end-stage renal disease,and is an important cause of death in patients with systemic lupus erythematosus.Treatment options include glucocorticoids,immunosuppressive agents and the addition of biologics.Recently,the therapeutic role of mesenchymal stem cells(MSCs)in LN has received extensive attention worldwide.MSCs can suppress autoimmunity,alleviate proteinuria and restore renal function by modulating the functions of various immune cells and reducing the secretion of inflammatory cytokines.Several clinical trials have investigated MSC treatment in LN with promising but sometimes inconsistent outcomes.This review summarizes the sources of MSCs and mechanisms in immunoregulation.Furthermore,it examines clinical trials evaluating the efficacy,safety,and limitations of MSC therapy in LN.By highlighting advances and ongoing challenges,this review underscores the potential of MSCs for LN treatment.More large-scale randomized controlled trials are needed to support the effectiveness of this therapy and pave the way for personalized and combinatorial therapeutic approaches.展开更多
Objective To compare the difference of therapeutic effects between vessel pricking therapy and Prednisone for treatment of henoch-schonlein purpura nephritis（HSPN）.Methods Seventy cases of acute purpura nephritis sy...Objective To compare the difference of therapeutic effects between vessel pricking therapy and Prednisone for treatment of henoch-schonlein purpura nephritis（HSPN）.Methods Seventy cases of acute purpura nephritis syndrome were randomly divided into an observation group （40 cases） and a control group （30 cases）.Patients in observation group were differentiated into sthenic and asthenic syndromes.Vessel pricking therapy was applied at Hégǔ（合谷 LI 4）,Qūchí（曲池 LI 11）,Xuèhǎi（血海 SP 10） etc.by three-edged needle for sthenic symptom;shallow needling was used at Píshū（脾俞 BL 20）,Shènshū（肾俞 BL 23）,Zúsānlǐ（足三里 ST 36） etc.by filiform needle for asthenic syndromes.The control group was treated with oral administration of Prednisone.The symptom score of TCM,24 h urinary protein,red blood cell count of urinary sediment of both groups were observed before and after treatment and therapeutic effects were compared.Results The total effective rate of 92.5%（37/40） in observation group was superior to that of 80.0%（24/30） in control group,and there was a significant difference between two groups （P0.05）;the symptom score of TCM,24 h urinary protein,red blood cell count of urinary sediment were all improved in both groups after treatment （all P0.05）,and moreover,the improvement in observation group was superior to that of control group （all P0.05）;after treatment,the symptom score of TCM of sthenic syndrome was lower than that of asthenic syndrome in observation group （P0.05）.Conclusion Vessel pricking therapy has a significant therapeutic effect for treatment of HSPN,superior to that of oral administration of Prednisone,and the therapeutic effect is better for treating sthenic syndrome than for asthenic syndrome.展开更多
Objective: To explore the effects of ligustrazine on proteinuria, serumcreati-nine, urinary thromboxane A_2(TxA_2), metabolism of prostacyclinI_2(PGI_2)―6-keto-PGF_(1α), and renal pathological changes of SD rats wit...Objective: To explore the effects of ligustrazine on proteinuria, serumcreati-nine, urinary thromboxane A_2(TxA_2), metabolism of prostacyclinI_2(PGI_2)―6-keto-PGF_(1α), and renal pathological changes of SD rats with passive Hermannnephritis (PHN). Methods: The PHN model was induced by intravenous injection of rabbit anti-ratrenal tubular epithelial antigen (Tub―Ag) an-tiserum to SD rats. I. P. administration ofligustrazine to rats was given every 2 d for 1 to 5 weeks. The proteinuria, creatinine, TxA_2 and6-keto-PGF_(1α) were measured by sulfosaticylic acid, picric acid, and direct radioimmunoassayrespectively. The renal pathological changes were observed under light microscope, electronicmicroscope and by direct immunofluorescence staining rabbit and rat IgG. Results: The PHN ratstreated with ligustrazine had significantly less proteinuria, serum creatinine, urinary TxA_2 andpathological changes of kidney, and more urinary 6-keto-PGF_(1α) than those without administrationof ligustrazine. Conclusion: Ligustrazine decreases proteinuria, urinary TxA_2, and renal tissueinjury and increases urinary 6-keto-PGF_(1α). These data indicate that ligustrazine may modulatethe balance of TxA_2 and PG I_2 in rat PHN model and can be used for preventing and treatingmembranous glomerulonephritis.展开更多
The clinical spectrum of immunoglobulin A vasculitis nephritis(IgAVN)ranges from the relatively common transitory microscopic hematuria and/or low-grade proteinuria to nephritic or nephrotic syndrome,rapidly progressi...The clinical spectrum of immunoglobulin A vasculitis nephritis(IgAVN)ranges from the relatively common transitory microscopic hematuria and/or low-grade proteinuria to nephritic or nephrotic syndrome,rapidly progressive glomerulonephritis,or even renal failure.Clinical and experimental studies have shown a multifactor pathogenesis:Infection triggers,impaired glycosylation of IgA1,complement activation,Toll-like-receptor activation and B cell proliferation.This knowledge can identify IgAVN patients at a greater risk for adverse outcome and increase the evidence for treatment recommendations.展开更多
Objective:To systematically evaluate the efficacy and safety of Nephritis Rehabilitation Tablet(NRT)combined with valsartan in treatment of chronic glomerulonephritis(CGN).Methods:Computer search databases such as CNK...Objective:To systematically evaluate the efficacy and safety of Nephritis Rehabilitation Tablet(NRT)combined with valsartan in treatment of chronic glomerulonephritis(CGN).Methods:Computer search databases such as CNKI,CBM,VIP,wanfang,Embase,PubMed and Cochrane library,and find all randomized controlled trials(RCTs)comparing NRT combined with valsartan versus valsartan in treatment of chronic glomerulonephritis.The search time limit is to build the database until October 2020.RCTs were screened according to the inclusion and exclusion criteria.After data extraction and quality assessment,the Cochrane risk of bias tool was used to evaluate the methodological quality of these studies.Meta-analysis was performed by Review Manager 5.2,and GRADE system for evidence quality evaluation.Results:We have identified a total of 24 eligible RCTs with 2082 participants and completed a meta-analysis based on these RCTs.The results of the meta-analysis showed that compared with valsartan,NRT combined with valsartan treatment showed effective curative effect in terms of effective treatment rate(OR=4.72;95%CI,3.67,6.08;P<0.00001),24h urine protein quantification(MD=-0.52;95%CI,-0.59,-0.44;P<0.00001),serum creatinine(Scr)(MD=-10.33;95%CI,-14.00,-6.66;P<0.00001),Systolic blood pressure(SBP)(MD=-11.42;95%CI,-17.67,-5.17;P=0.0003),Diastolic blood pressure(DBP)(MD=-6.28;95%CI,-9.14,-3.42;P<0.0001),Blood urine nitrogen(BUN)(MD=-0.02;95%CI,-0.41,0.37;P=0.93),plasma albumin(ALB)(MD=5.05;95%CI,4.27,5.84;P<0.00001),and adverse reactions(OR=0.93,95%CI,0.54,1.60;P=0.78).No serious adverse events were mentioned in these studies.And based on the results of the systematic review,the GRADE system recommended ranking method was used to evaluate the quality of evidence and the recommendation level.The results showed that the level of evidence was moderate and the recommendation intensity was weak recommendation.Conclusions:NRT combined with valsartan has a significant effect on the treatment of CGN,and the treatment effect is better than valsartan alone.There are no obvious adverse reactions during the treatment process.However,due to the generally low quality of the literature included in these studies,and the variability of the evaluation methods of each study,morelarge samples,multi-center,high-quality samples are still needed RCTs are further verified.展开更多
Staphylococcus associated glomerulonephritis (SAGN) is an uncommon infection-related glomerulonephritis. Although infection is typically ongoing when patients present with SAGN, in the case of deep-seated infections, ...Staphylococcus associated glomerulonephritis (SAGN) is an uncommon infection-related glomerulonephritis. Although infection is typically ongoing when patients present with SAGN, in the case of deep-seated infections, the presence of infection may not be apparent. The aim of this study is to highlight the importance of renal biopsy when the diagnosis is not obvious. We present a case of staphylococcus associated glomerulonephritis in a patient treated with beta-lactam antibiotics for staphylococcus bacteraemia. A renal biopsy helped differentiate between interstitial nephritis and staphylococcus associated glomerulonephritis.展开更多
Membranous lupus nephritis(MLN),class V,is a distinct LN characterized by immune complex deposition on subepithelial kidney biopsy.MLN is often associated with nephrotic syndrome.The histology of MLN is very similar t...Membranous lupus nephritis(MLN),class V,is a distinct LN characterized by immune complex deposition on subepithelial kidney biopsy.MLN is often associated with nephrotic syndrome.The histology of MLN is very similar to idiopathic(primary)membranous nephropathy(pMN).However,MLN usually has abundant mesa-glomerular deposits absent in primary membranous nephropathy.The clinical manifestations,management,and prognosis of MLN differ from other types of LN(type III,IV,or mixed type III/IV+V).Although immunosuppressive therapy is often necessary for MLN,the optimal treatment regimen is yet to be determined.This review summarizes the progress in the diagnosis and treatment of MLN and discusses the selection of immunosuppressants for MLN.展开更多
Objective： The treatment of Henoch-Schonlein purpura （HSP） with moderate proteinuria remains con- troversial. We retrospectively analyzed the efficacy of immune suppressants, with a particular emphasis on myco- phe...Objective： The treatment of Henoch-Schonlein purpura （HSP） with moderate proteinuria remains con- troversial. We retrospectively analyzed the efficacy of immune suppressants, with a particular emphasis on myco- phenolate mofetil （MMF）. Methods： Ninety-five HSP patients with moderate proteinuria （1.0-3.5 g/24 h） after at least three months of therapy with angiotensin-converting enzyme inhibitor （ACEI） or angiotensin receptor blocker （ARB） were divided into three groups： an MMF group （n=33） that received MMF 1.0-1.5 g/d combined with prednisone （0.4-0.5 mg/（kg.d））, a corticosteroid （CS） group （n=31） that received full-dose prednisone （0.8-1.0 mg/（kg.d））, and a control group （n=31）. Patients in the MMF and CS groups continued to take ACEI or ARB at the original dose. The patients in the control group continued to take ACEI or ARB but the dose was increased by （1.73±0.58）-fold. The patients were followed up for 6-78 months （median 28 months）. Results： The baseline proteinuria was higher in the MMF group （（2.1±0.9） g/24 h） than in the control group （（1.6±0.8） g/24 h） （P=0.039）. The proteinuria decreased sig- nificantly in all groups during follow-up, but only in the MMF group did it decrease significantly after the first month. At the end of follow-up, the proteinuria was （0.4±0.7） g/24 h in the MMF group and （0.4±0.4） g/24 h in the CS group, significantly lower than that in the control group （（0.9±1.1） g/24 h）. The remission rates in the MMF group, CS group, and control group were respectively 72.7%, 71.0%, and 48.4% at six months and 72.7%, 64.5%, and 45.2% at the end of follow-up. The overall number of reported adverse events was 17 in the MMF group, 30 in the CS group, and 6 in the control group （P〈0.001）. Conclusions： MMF with low-dose prednisone may be as effective as full-dose prednisone and tend to have fewer adverse events. Therefore, it is probably superior to conservative treatments of adult HSP patients with moderate proteinuria.展开更多
This study investigated the relationship between angiotensin-converting enzyme (ACE) gene insertion/deletion polymorphism and the occurrence, severity, prognosis of HSPN. The polymorphism of ACE gene in 103 HSPN case...This study investigated the relationship between angiotensin-converting enzyme (ACE) gene insertion/deletion polymorphism and the occurrence, severity, prognosis of HSPN. The polymorphism of ACE gene in 103 HSPN cases and 100 healthy children was studied by using the polymerase chain reactions (PCR). Its relation to the clinical manifestation, pathological classification and prognosis of HSPN was analyzed accordingly. The results showed that: (1) there was a significantly higher frequency for DD genotype in HSPN children (P<0.01); (2) DD genotype was more frequently seen in HSPN children with gross hematuria and massive proteinuria (P<0.05), while DI genotype was more common in HSPN children group with renal insufficiency (P<0.05); (3) although mesangial proliferative lesion was most frequently observed in 21 biopsied HSPN children, and DD genotype frequency was still higher in children with severe pathology (Class Ⅲ Ⅳ); (4)II genotype was significantly frequent in HSPN children with complete remission in the follow-up of 32 HSPN children. It was concluded that the deletion allele of ACE gene might play a role, at least to some extent, in the occurrence, deterioration and progression in juvenile HSPN.展开更多
BACKGROUND Idiopathic membranous nephropathy(IMN)has a high incidence in the middleaged and elderly population,and poses a great threat to the physical and mental health and quality of life of patients.Nephritis Rehab...BACKGROUND Idiopathic membranous nephropathy(IMN)has a high incidence in the middleaged and elderly population,and poses a great threat to the physical and mental health and quality of life of patients.Nephritis Rehabilitation Tablets have many potential effects,such as clearing residual toxins,tumefying the kidney and spleen,replenishing qi,and nourishing yin,and have played an important role in the treatment of a variety of kidney diseases.AIM To investigate the efficacy and safety of Nephritis Rehabilitation Tablets combined with tacrolimus in the treatment of IMN.METHODS Eighty-four patients with IMN recruited from January 2017 to September 2020 were randomly divided into a study group(n=42)and a control group(n=42).On the basis of routine symptomatic treatment,both groups were treated with tacrolimus,and the study group was additionally treated with Nephritis Rehabilitation Tablets.Both groups were treated for 12 wk.The therapeutic effect,the levels of renal function indexes[serum creatinine(Scr),serum albumin,and 24-h urinary protein],urinary immunoglobulin(IgG4),membrane attack complex(C5b-9),and the incidence of adverse reactions were measured before and after 12 wk of treatment.RESULTS The total effective rate in the study group was significantly higher than that of the control group.Before treatment,there was no significant difference in Scr,serum albumin,or 24 h urinary protein between the two groups.After 12 wk of treatment,the levels of Scr and 24-h urinary protein in both groups were significantly lower and serum albumin was significantly higher than those before treatment(P<0.05),and the levels of Scr and 24-h urinary protein were significantly lower(P=0.003 and 0.000,respectively),and the level of serum albumin was significantly higher(P=0.00)in the study group than in the control group.Before treatment,there was no significant difference in urinary IgG4 and C5b-9 levels between the study group and the control group(P=0.336 and 0.438,respectively).After 12 wk of treatment,the levels of urinary IgG4 and C5b-9 in the two groups were lower than those before treatment,and the levels of urinary IgG4 and C5b-9 in the study group were significantly lower than those in the control group(P=0.000).There was no significant difference in the incidence of adverse reactions between the two groups(P=0.710).CONCLUSION Based on routine intervention,Nephritis Rehabilitation Tablets combined with tacrolimus in the treatment of IMN can effectively improve the renal function of patients and downregulate the expression of urinary IgG4 and C5b-9.In addition,they can improve the overall therapeutic effect while not increasing the risk of adverse reactions.展开更多
OBJECTIVE:To investigate the effectiveness and safety of tripterygium glycosides(TG)tablet(雷公藤多苷片)for the treatment of Lupus nephritis(LN).METHODS:Several databases were systematically searched including Pub Med...OBJECTIVE:To investigate the effectiveness and safety of tripterygium glycosides(TG)tablet(雷公藤多苷片)for the treatment of Lupus nephritis(LN).METHODS:Several databases were systematically searched including Pub Med,Embase,Cochrane,Wiley,China National Knowledge Infrastructure Database,Sino Med and Wanfang Library till June 20,2020.Revman5.3 was utilized to analyze the data according to the Preferred Reporting Items for Systematic Reviews and Meta-Analyses Statement.RESULTS:In total,8 randomized controlled trials involving 583 participants were identified.Meta-analyses showed that,compared with glucocorticoids(GC)alone,the combination with TG tablet provided a statistically significant improvement in total remission(TR)(RR=1.27,95%CI:1.08–1.50,P=0.004),complete remission(CR)(RR=1.61,95%CI:1.05–2.47,P=0.03)and C3 levels(WMD=0.27,95%CI:0.14–0.39,P<0.0001),C4 levels(WMD=0.12,95%CI:0.07–0.17,P<0.00001).No significant differences were seen in TR,CR,proteinuria,serum creatinine,C3 and C4(TR:RR=1.00,95%CI:0.87–1.16,P=0.95;CR:RR=1.10,95%CI:0.78–1.56,P=0.58;proteinuria levels:WMD=-0.06,95%CI:-0.13 to 0.01,P=0.10;serum creatinine levels:WMD=-0.01,95%CI:-7.36 to 7.35,P=1.00;C3 levels:WMD=0.01,95%CI:-0.06 to 0.07,P=0.84;C4 levels:WMD=-0.01,95%CI:-0.03 to 0.01,P=0.49)between azathioprine(AZA)/leflomit(LEF)+GC and TG tablet+GC.Adverse events(hepatic dysfunction,nausea,vomitting)showed no statistical differences between the TG tablet+GC group and the GC group.There were more new onset of irregular menstruation in the TG tablet+GC group than those in the AZA+GC(RR=3.57,95%CI:1.40–9.11,P=0.008)/LEF+GC(RR=6.69,95%CI:2.42-18.46,P=0.0002)group,but leucopenia lower than those in AZA+GC group(RR=0.38,95%CI:0.17-0.85,P=0.02)and alopecia(RR=0.14,95%CI:0.03-0.77,P=0.02)and rash(RR=0.09,95%CI:0.01-0.69,P=0.02)lower than those in LEF+GC group.Conclusions:This review indicates that TG tablet maybe effective in LN treatment.Nevertheless,adverse events cannot be ignored.Large sample,multi-center,highquality clinical studies are needed to verify the exact effects and safety of TG tablet in treatment of LN.展开更多
BACKGROUND Purpura nephritis,also called Henoch-Schönlein purpura nephritis,is a systemic disease with small dead vasculitis as the main pathological change.AIM To observe the influence of transitional nursing ac...BACKGROUND Purpura nephritis,also called Henoch-Schönlein purpura nephritis,is a systemic disease with small dead vasculitis as the main pathological change.AIM To observe the influence of transitional nursing activities on the compliance behaviors and disease knowledge of children with purpura nephritis.METHODS A total of 82 children with purpura nephritis were included and divided into a general nursing group(41 children)and transitional nursing group(41 children)using the envelope method.The general nursing group received routine nursing care,while the transitional nursing group received transitional nursing care.The behaviors,knowledge of the disease,and self-management ability of the two groups were evaluated after nursing care was provided.RESULTS The scores of four items(self-care ability,self-responsibility,health knowledge level,and self-concept)in the transitional nursing group were significantly higher than those in the general nursing group.CONCLUSION Transitional nursing can directly improve the disease knowledge level and selfmanagement ability of children with purpura nephritis and effectively reduce complications.展开更多
The level of urinary FPA was assayed by high per formance liquid chromatography (HPLC ) in 42 normal controls, 57 cases of chronic glomeru-lonephritis, including 24 with normal renal function, 12 with renal insufficie...The level of urinary FPA was assayed by high per formance liquid chromatography (HPLC ) in 42 normal controls, 57 cases of chronic glomeru-lonephritis, including 24 with normal renal function, 12 with renal insufficiency and 21 with uremia. Their levels were 24. 40± 10. 30 μg/L, 26. 99±5.77 μg/L,38. 81±6. 28 μg/L, 79. 74± 18. 76 μg/L, respectively. The level of urinary FPA in renal insufficiency function group was significantly higher than those of the con-trol group and normal renal function group (P<0.01). The patients with uremia presented dramatically higher level of urinary FPA than those in the renal insufficiency group (P<0.01). A positive correlation was found between the level of urinary FPA and the blood creatine (r= 0. 9120, P<0. 01 ). It was suggested that a hypercoagulable state existed in the patients with chronic nephritis with renal failure, in which the severity was closely related with the occurrence and development of the disease. The urinary FPA could serve as a good indicator for renal function.展开更多
BACKGROUND Immunoglobulin G4-related disease (IgG4-RD) is an immune-mediated condition that consisted of disorders that share particular clinical,serologic and pathologic properties.The common presentation of disease ...BACKGROUND Immunoglobulin G4-related disease (IgG4-RD) is an immune-mediated condition that consisted of disorders that share particular clinical,serologic and pathologic properties.The common presentation of disease includes tumor-like swelling of involved organs and the histopathological findings are a lymphoplasmacytic infiltrate enriched with IgG4-positive plasma cells,and a variable degree of fibrosis that has a characteristic "storiform" pattern in biopsy specimens of tumorlike masses.Major presentations of this disease,which often affects more than one organ,include autoimmune pancreatitis,salivary gland disease (sialadenitis),orbital disease and retroperitoneal fibrosis.The steroid treatment is essential for the treatment of the disease however,other immunosuppressive drugs including cyclophosphamide or rituximab could be an option in resistant cases.CASE SUMMARY Herein,we reported a 34-year-old woman whom previously had diagnosed with asthma,rheumatoid arthritis and Sj?gren’s syndrome (SS) referred our nephrology department due to acute kidney failure development at the last rheumatology visit.After kidney biopsy she has been diagnosed with IgG4-RD and tubuluointerstitial nephritis.She had been accepted resistant to steroid,mycophenolate mofetil,methotrexate and azathioprine therapies due to receiving in last two years.She refused to receive cyclophosphamide due to potential gonadotoxicity of the drug.Thus,rituximab therapy was considered.She received 1000 mg infusion,15 d apart and 6 mo later it has been administered same protocol.After one year from the last rituximab dose serum creatinine decreased from 4.4 mg/dL to 1.6 mg/dL,erythrocyte sedimentation rate decreased from 109 mm/h to 13 mm/h [reference range (RR) 0-20],and Creactive protein decreased from 55.6 mg/L to 5 mg/L (RR 0–6).All pathologic lymph nodes and masses were also disappeared.CONCLUSION Patients with IgG4-RD usually misdiagnosed with rheumatologic diseases including systemic lupus erythematous or SS and also they were screened for the presence of malignancy.Rituximab could be an important treatment option in cases with steroid resistant tubulointerstitial nephritis in IgG4-RD.展开更多
To elucidate the mechanism underlying the therapeutic impact of Astragalus-Danshen in chronic glomerulonephritis(CGN),a comprehensive exploration was conducted utilizing network pharmacology.The TCMSP database was emp...To elucidate the mechanism underlying the therapeutic impact of Astragalus-Danshen in chronic glomerulonephritis(CGN),a comprehensive exploration was conducted utilizing network pharmacology.The TCMSP database was employed to aggregate the chemical constituents and targets associated with Astragalus and Danshen.Simultaneously,disease targets specific to CGN were sourced from the Genecards database.The convergence of these datasets yielded a set of intersection genes,representing potential targets for CGN treatment through Astragalus-Danshen formulations.Subsequently,protein interaction networks and“chemical composition-target”networks were meticulously constructed.Core targets were subjected to GO and KEGG enrichment analyses.The investigation revealed a total of 240 targets corresponding to 20 and 65 chemical components of Astragalus and Danshen,respectively.From this pool,86 potential targets associated with CGN treatment were discerned,ultimately identifying 29 core targets.Noteworthy among these were TNF,JUN,TP53,IL1B,RELA,MMP9,CASP3,IL10,MAPK14,MYC,and TGFB1.KEGG enrichment analysis illuminated pathways pertinent to CGN,encompassing the IL-17 signaling pathway,TNF signaling pathway,and the AGE-RAGE signaling pathway in diabetic complications.In summary,Astragalus-Danshen exhibited a potential anti-inflammatory and renoprotective effect on CGN,particularly through modulating the IL-17 signaling pathway,TNF signaling pathway,and AGE-RAGE signaling pathway in diabetic complications,involving key regulators such as TNF,JUN,TP53,IL1B,MAPK14,and others.展开更多
Recent advances in the management of lupus nephritis, together with earlier renal biopsy and selective use of aggressive immunosuppressive therapy, have contribut-ed to a favorable outcome in children and adolescents ...Recent advances in the management of lupus nephritis, together with earlier renal biopsy and selective use of aggressive immunosuppressive therapy, have contribut-ed to a favorable outcome in children and adolescents with systemic lupus erythematosus （SLE）. Neverthe-less, we believe that a more effective and less toxic treatment is needed to attain an optimal control of the activity of lupus nephritis. Recent published papers and our experiences regarding treatment of young patients with lupus nephritis using calcineurin inhibitors are re-viewed. Although it has been reported that intermittent monthly pulses of intravenous cyclophosphamide （IVCY） are effective for preserving renal function in adult pa-tients, CPA is a potent immunosuppressive agent thatinduces severe toxicity, including myelo- and gonadal toxicity, and increases the risk of secondary malig-nancy. Thus, treatment for controlling lupus nephritis activity, especially in children and adolescents, remains challenging. Cyclosporine A （CsA） and tacrolimus （Tac） are T-cell-specific calcineurin inhibitors that prevent the activation of helper T cells, thereby inhibiting thetranscription of the early activation genes of interleu-kin （IL）-2 and suppressing T cell-induced activation of tumor necrosis factor-α, IL-1β and IL-6. Therefore, both drugs, which we believe may be less cytotoxic, are attractive therapeutic options for young patients with lupus nephritis. Recently, a multidrug regimen of prednisolone （PDN）, Tac, and mycophenolate mofetile （MMF） has been found effective and relatively safe in adult lupus nephritis. Since the mechanisms of action of MMF and Tac are probably complementary, multidrug therapy for lupus nephritis may be useful. We propose as an alternative to IVCY, a multidrug therapy with mizoribine, which acts very similarly to MMF, and Tac, which has a different mode of action, combined with PDN for pediatric-onset lupus nephritis. We also believe that a multidrug therapy including CsA and Tac may bean attractive option for young patients with SLE and lupus nephritis展开更多
文摘BACKGROUND Proliferative lupus nephritis(PLN)is the most severe form of lupus nephritis(LN).There are limited data available on renal outcomes of PLN from developing countries.AIM To determine the clinicopathological characteristics and long-term outcomes in terms of remission,requirement of kidney replacement therapy(KRT),and patient survival.METHODS A retrospective analysis was conducted on biopsy-proven focal or diffuse PLN cases diagnosed between 1998 and 2019 at the Sindh Institute of Urology and Transplantation and followed up at the renal clinic for a minimum of 5 years.All patients were induced with a combination of intravenous cyclophosphamide and corticosteroids for 6 months,followed by maintenance treatment with azathioprine(AZA)or mycophenolate mofetil(MMF).Data were analyzed using Statistical Package for the Social Sciences,version 22.0.P≤0.05 was considered statistically significant.RESULTS The mean age at the onset of systemic lupus erythematosus was 24.12 years±8.89 years,and at LN onset,26.63 years±8.61 years.There was a female predominance of 184(88.9%)cases.Among baseline characteristics,reduced estimated glomerular filtration rate,presence of hypertension,requirement of KRT,and underlying renal histology(International Society of Nephrology/Renal Pathology Society class IV than class III)were significantly associated with end-stage kidney disease(ESKD)and mortality.The renal outcomes were negatively correlated with age,duration of symptoms,and 24-hour urinary protein excretion.The overall remission rate was 89.8%at the end of induction therapy.At 5 years,141(68.11%)patients were in complete and partial remission(94[45.4%]and 47[22.7%],respectively).In total,19(9.2%)patients required KRT on presentation,and at 5 years,38(18.4%)patients developed ESKD,and 28(13.5%)patients died.Thirty-four(16.4%)patients had a renal relapse,more with AZA than MMF(30[88.2%]vs 4[11.76%],respectively;P=0.04).Renal survival at 6 months was 89.8%,while at 5 years,it was 68.11%,showing a significant improvement in patients who did not need KRT at the time of presentation(P<0.0001).CONCLUSION Baseline renal functions,requirement of KRT,and diffuse proliferative disease were the most relevant prognostic factors for kidney survival among this cohort.Short-term renal outcomes were good.Long-term outcomes were poorer with AZA-based maintenance therapy than with MMF,with more ESKD and mortality.
文摘Objective To review and synthesize preclinical and clinical evidence regarding traditional Chinese medicine(TCM)formulations and bioactive herbal compounds in lupus nephritis(LN),and to identify direction and research priorities for integrating TCM with professional care.Methods A narrative literature review was conducted by searching Scopus,PubMed,Web of Science,and Google Scholar for articles published between January 1,2011 and March 31,2024.Search terms combined controlled vocabulary[e.g.,medical subject headings(MeSH)]and free-text words including lupus nephritis,traditional Chinese medicine,Chinese herbal medicine,formulation,and names of specific herbs[Leigongteng(Tripterygii Wilfordii Radix et Rhizoma),Baishao(Paeoniae Radix Alba),and Yinghao(Artemisiae Annuae Herba)].Both randomized controlled trials and observational studies were included,along with mechanistic preclinical studies and pharmacologic investigations.Inclusion criteria were studies that reported renal outcomes(proteinuria and estimated glomerular filtration rate),immunemodulatory mechanisms,or safety and herb-drug interaction data.Studies without primary data,case reports,or those lacking relevance to LN were excluded.References of key articles were manually screened to identify additional eligible studies.Results TCM formulas[e.g.,Liuwei Dihuang Pills(六味地黄丸),Zhibai Dihuang Pills(知柏地黄丸),and Huanglian Jiedu Decoction(黄连解毒汤)]and herbal medicines[e.g.,extracts from Leigongteng(Tripterygii Wilfordii Radix et Rhizoma),Baishao(Paeoniae Radix Alba),and Yinghao(Artemisiae Annuae Herba)]were commonly used in the above studies.TCM formulations and their constituent compounds showed multi-modal mechanisms relevant to LN pathogenesis,encompassing immunomodulation(reduction of autoreactive B/T cell activity,regulatory T cell enhancement),inhibition of pro-inflammatory signaling pathways nuclear factor kappa-light-chain-enhancer of activated B cells(NF-κB),mitogen-activated protein kinase(MAPK),nucleotide-binding oligomerization domain(NOD),leucine-rich repeat(LRR)and pyrin domain-containing protein 3(NLRP3 inflammasome),anti-fibrotic and antioxidant effects,and direct renal-protective properties.In many studies,these indicators can reduce proteinuria and improve renal function.Clinical data,while promising,are heterogeneous in design,sample size,endpoints,and TCM formulation standardization.Safety concerns(notably with Tripterygium preparations)and potential herb-drug interactions with immunosuppressants remained important considerations.Conclusion TCM offers biologically plausible and multi-targeted adjuvant strategies for LN that may enhance therapeutic efficacy and reduce toxicity when combined with modern therapies.To translate these promises into clinical practice,future work should prioritize the standardization of TCM preparations,randomized controlled trials with clinically meaningful renal endpoints,elucidation of molecular mechanisms,and systematic evaluation of pharmacokinetic and safety interactions.Such integrative research will be essential to define the TCM’s role in evidence-based,patient-centered LN management.
文摘Objective To clarify the causal relationship between the level of cytoplasmic unactivated mineralocorticoid receptor(MR)and the development of tubulointerstitial nephritis(TIN),and to evaluate the impact of MR on dyslipidemia,particularly secondary hyperlipemia,in patients with diabetic kidney disease.Methods We conducted a two-sample Mendelian randomization study using genome-wide association study(GWAS)summary data.Genetic variants associated with MR levels were selected as exposures,with TIN and lipid profiles[including low-density lipoprotein cholesterol(LDL-C),triglyceride,and high-density lipoprotein cholesterol]as outcomes.A two-step Mendelian randomization approach was used to assess TIN as a mediator,employing inverse variance weighted regression as the primary analysis,supplemented by Mendelian randomization-Egger,weighted median,and sensitivity analyses.Results Cytoplasmic unactivated MR level exhibited a significant causal association with a decreased risk of TIN(OR=0.8598,95%CI[0.7775-0.9508],P<0.001).Although no significant causal relationship was identified between MR level and secondary hyperlipemia,a potential association of cytoplasmic unactivated MR level with lower LDL-C levels was observed(OR=0.9901,95%CI[0.9821-0.9983],P=0.018).Additionally,TIN exhibited causal links with secondary hyperlipemia(OR=1.0016,95%CI[1.0002-1.0029],P=0.020)and elevated LDL-C(OR=1.0111,95%CI[1.0024-1.0199],P=0.012),particularly LDL-C in European males(OR=1.0230,95%CI[1.0103-1.0358],P<0.001).Inverse Mendelian randomization analysis revealed causal relationships between TIN and genetically predicted triglyceride(OR=0.7027,95%CI[0.6189-0.7978],P<0.001),high-density lipoprotein cholesterol(OR=1.1247,95%CI[1.0019-1.2626],P=0.046),and LDL-C(OR=0.8423,95%CI[0.7220-0.9827],P=0.029).Notably,TIN mediated 16.7%of the causal association between MR and LDL-C levels.Conclusions MR plays a critical role in the development of TIN and lipid metabolism,highlighting the potential of MR-antagonists in reducing renal damage and lipid metabolism-associated complications.
文摘Pediatric lupus nephritis(LN)is a challenging and severe condition in pediatrics.Traditional Chinese medicine(TCM)has shown significant advantages in improving immune disorders,reducing recurrence rates,and mitigating the toxic side effects of Western medications.However,it faces challenges such as the lack of a unified TCM syndrome differentiation system,insufficient standardization of dynamic syndrome differentiation,an incomplete efficacy evaluation system,and a lack of precise intervention methods.This study focuses on the clinical advantages of TCM.On 1 September 2024,the 35th Clinical Advantage Disease Series Salon was held in Zhengzhou,discussing the advantages of TCM and integrated Chinese-Western medicine in treating pediatric LN.Experts in TCM and integrated Chinese-Western medicine,along with interdisciplinary researchers,conducted extensive and in-depth discussions.They proposed specific recommendations for TCM and integrated Chinese-Western medicine in treating pediatric LN and reached a consensus.Based on this,the study analyzes the challenges in treating pediatric LN from the perspective of its development patterns,and summarizes three key areas and six research directions to highlight the advantages of TCM and integrated Chinese-Western medicine in treating pediatric LN.It focuses on three key areas:The construction of a TCM system for pediatric LN,the prevention and treatment of complications,and chronic disease management.And it proposes six research directions:(1)Constructing a syndrome differentiation system for pediatric LN;(2)Formulating TCM and integrated Chinese-Western medicine guidelines for pediatric LN;(3)Researching the mechanisms of enhancing efficacy and reducing toxicity in integrated Chinese-Western medicine for pediatric LN;(4)Preventing and treating complications in pediatric LN;(5)Developing and researching TCM regimens for preventing and treating the recurrence of pediatric LN;(6)Strategies for the full-cycle chronic disease management of pediatric LN.Finally,the study summarizes and generalizes the technological layout and research directions for pediatric LN.Therefore,based on the series of salons on traditional Chinese medicine advantages for children LN diseases,this paper puts forward a research paradigm of scientific and technological breakthroughs for children LN,in order to provide reference for the construction and research direction of children LN diagnosis and treatment system with traditional Chinese medicine characteristics.
基金Supported by Natural Science Foundation of Zhejiang Province,No.LY23H050005Zhejiang Medical Technology Project,No.2020KY439,No.2022RC009,No.2024KY645,and No.2024KY697.
文摘Lupus nephritis(LN)is one of the most common and serious complications of systemic lupus erythematosus,which can lead to end-stage renal disease,and is an important cause of death in patients with systemic lupus erythematosus.Treatment options include glucocorticoids,immunosuppressive agents and the addition of biologics.Recently,the therapeutic role of mesenchymal stem cells(MSCs)in LN has received extensive attention worldwide.MSCs can suppress autoimmunity,alleviate proteinuria and restore renal function by modulating the functions of various immune cells and reducing the secretion of inflammatory cytokines.Several clinical trials have investigated MSC treatment in LN with promising but sometimes inconsistent outcomes.This review summarizes the sources of MSCs and mechanisms in immunoregulation.Furthermore,it examines clinical trials evaluating the efficacy,safety,and limitations of MSC therapy in LN.By highlighting advances and ongoing challenges,this review underscores the potential of MSCs for LN treatment.More large-scale randomized controlled trials are needed to support the effectiveness of this therapy and pave the way for personalized and combinatorial therapeutic approaches.
基金Supported by Research Project of Administration of Traditional Chinese Medicine of Hebei Province:2009128
文摘Objective To compare the difference of therapeutic effects between vessel pricking therapy and Prednisone for treatment of henoch-schonlein purpura nephritis（HSPN）.Methods Seventy cases of acute purpura nephritis syndrome were randomly divided into an observation group （40 cases） and a control group （30 cases）.Patients in observation group were differentiated into sthenic and asthenic syndromes.Vessel pricking therapy was applied at Hégǔ（合谷 LI 4）,Qūchí（曲池 LI 11）,Xuèhǎi（血海 SP 10） etc.by three-edged needle for sthenic symptom;shallow needling was used at Píshū（脾俞 BL 20）,Shènshū（肾俞 BL 23）,Zúsānlǐ（足三里 ST 36） etc.by filiform needle for asthenic syndromes.The control group was treated with oral administration of Prednisone.The symptom score of TCM,24 h urinary protein,red blood cell count of urinary sediment of both groups were observed before and after treatment and therapeutic effects were compared.Results The total effective rate of 92.5%（37/40） in observation group was superior to that of 80.0%（24/30） in control group,and there was a significant difference between two groups （P0.05）;the symptom score of TCM,24 h urinary protein,red blood cell count of urinary sediment were all improved in both groups after treatment （all P0.05）,and moreover,the improvement in observation group was superior to that of control group （all P0.05）;after treatment,the symptom score of TCM of sthenic syndrome was lower than that of asthenic syndrome in observation group （P0.05）.Conclusion Vessel pricking therapy has a significant therapeutic effect for treatment of HSPN,superior to that of oral administration of Prednisone,and the therapeutic effect is better for treating sthenic syndrome than for asthenic syndrome.
文摘Objective: To explore the effects of ligustrazine on proteinuria, serumcreati-nine, urinary thromboxane A_2(TxA_2), metabolism of prostacyclinI_2(PGI_2)―6-keto-PGF_(1α), and renal pathological changes of SD rats with passive Hermannnephritis (PHN). Methods: The PHN model was induced by intravenous injection of rabbit anti-ratrenal tubular epithelial antigen (Tub―Ag) an-tiserum to SD rats. I. P. administration ofligustrazine to rats was given every 2 d for 1 to 5 weeks. The proteinuria, creatinine, TxA_2 and6-keto-PGF_(1α) were measured by sulfosaticylic acid, picric acid, and direct radioimmunoassayrespectively. The renal pathological changes were observed under light microscope, electronicmicroscope and by direct immunofluorescence staining rabbit and rat IgG. Results: The PHN ratstreated with ligustrazine had significantly less proteinuria, serum creatinine, urinary TxA_2 andpathological changes of kidney, and more urinary 6-keto-PGF_(1α) than those without administrationof ligustrazine. Conclusion: Ligustrazine decreases proteinuria, urinary TxA_2, and renal tissueinjury and increases urinary 6-keto-PGF_(1α). These data indicate that ligustrazine may modulatethe balance of TxA_2 and PG I_2 in rat PHN model and can be used for preventing and treatingmembranous glomerulonephritis.
文摘The clinical spectrum of immunoglobulin A vasculitis nephritis(IgAVN)ranges from the relatively common transitory microscopic hematuria and/or low-grade proteinuria to nephritic or nephrotic syndrome,rapidly progressive glomerulonephritis,or even renal failure.Clinical and experimental studies have shown a multifactor pathogenesis:Infection triggers,impaired glycosylation of IgA1,complement activation,Toll-like-receptor activation and B cell proliferation.This knowledge can identify IgAVN patients at a greater risk for adverse outcome and increase the evidence for treatment recommendations.
基金The Second Affiliated Hospital of Shaanxi University of Traditional Chinese Medicine(No.2020XKTD-A04)Disciplinary Innovation Team Plan of Shaanxi University of Traditional Chinese Medicine(No.2019-QN02)。
文摘Objective:To systematically evaluate the efficacy and safety of Nephritis Rehabilitation Tablet(NRT)combined with valsartan in treatment of chronic glomerulonephritis(CGN).Methods:Computer search databases such as CNKI,CBM,VIP,wanfang,Embase,PubMed and Cochrane library,and find all randomized controlled trials(RCTs)comparing NRT combined with valsartan versus valsartan in treatment of chronic glomerulonephritis.The search time limit is to build the database until October 2020.RCTs were screened according to the inclusion and exclusion criteria.After data extraction and quality assessment,the Cochrane risk of bias tool was used to evaluate the methodological quality of these studies.Meta-analysis was performed by Review Manager 5.2,and GRADE system for evidence quality evaluation.Results:We have identified a total of 24 eligible RCTs with 2082 participants and completed a meta-analysis based on these RCTs.The results of the meta-analysis showed that compared with valsartan,NRT combined with valsartan treatment showed effective curative effect in terms of effective treatment rate(OR=4.72;95%CI,3.67,6.08;P<0.00001),24h urine protein quantification(MD=-0.52;95%CI,-0.59,-0.44;P<0.00001),serum creatinine(Scr)(MD=-10.33;95%CI,-14.00,-6.66;P<0.00001),Systolic blood pressure(SBP)(MD=-11.42;95%CI,-17.67,-5.17;P=0.0003),Diastolic blood pressure(DBP)(MD=-6.28;95%CI,-9.14,-3.42;P<0.0001),Blood urine nitrogen(BUN)(MD=-0.02;95%CI,-0.41,0.37;P=0.93),plasma albumin(ALB)(MD=5.05;95%CI,4.27,5.84;P<0.00001),and adverse reactions(OR=0.93,95%CI,0.54,1.60;P=0.78).No serious adverse events were mentioned in these studies.And based on the results of the systematic review,the GRADE system recommended ranking method was used to evaluate the quality of evidence and the recommendation level.The results showed that the level of evidence was moderate and the recommendation intensity was weak recommendation.Conclusions:NRT combined with valsartan has a significant effect on the treatment of CGN,and the treatment effect is better than valsartan alone.There are no obvious adverse reactions during the treatment process.However,due to the generally low quality of the literature included in these studies,and the variability of the evaluation methods of each study,morelarge samples,multi-center,high-quality samples are still needed RCTs are further verified.
文摘Staphylococcus associated glomerulonephritis (SAGN) is an uncommon infection-related glomerulonephritis. Although infection is typically ongoing when patients present with SAGN, in the case of deep-seated infections, the presence of infection may not be apparent. The aim of this study is to highlight the importance of renal biopsy when the diagnosis is not obvious. We present a case of staphylococcus associated glomerulonephritis in a patient treated with beta-lactam antibiotics for staphylococcus bacteraemia. A renal biopsy helped differentiate between interstitial nephritis and staphylococcus associated glomerulonephritis.
文摘Membranous lupus nephritis(MLN),class V,is a distinct LN characterized by immune complex deposition on subepithelial kidney biopsy.MLN is often associated with nephrotic syndrome.The histology of MLN is very similar to idiopathic(primary)membranous nephropathy(pMN).However,MLN usually has abundant mesa-glomerular deposits absent in primary membranous nephropathy.The clinical manifestations,management,and prognosis of MLN differ from other types of LN(type III,IV,or mixed type III/IV+V).Although immunosuppressive therapy is often necessary for MLN,the optimal treatment regimen is yet to be determined.This review summarizes the progress in the diagnosis and treatment of MLN and discusses the selection of immunosuppressants for MLN.
基金supported by the National Key Technology R&D Program of China(No.2013BAI09B04)the Medical Research Funds from the Bureau of Health of Zhejiang Province(No.2013KYA072),China
文摘Objective： The treatment of Henoch-Schonlein purpura （HSP） with moderate proteinuria remains con- troversial. We retrospectively analyzed the efficacy of immune suppressants, with a particular emphasis on myco- phenolate mofetil （MMF）. Methods： Ninety-five HSP patients with moderate proteinuria （1.0-3.5 g/24 h） after at least three months of therapy with angiotensin-converting enzyme inhibitor （ACEI） or angiotensin receptor blocker （ARB） were divided into three groups： an MMF group （n=33） that received MMF 1.0-1.5 g/d combined with prednisone （0.4-0.5 mg/（kg.d））, a corticosteroid （CS） group （n=31） that received full-dose prednisone （0.8-1.0 mg/（kg.d））, and a control group （n=31）. Patients in the MMF and CS groups continued to take ACEI or ARB at the original dose. The patients in the control group continued to take ACEI or ARB but the dose was increased by （1.73±0.58）-fold. The patients were followed up for 6-78 months （median 28 months）. Results： The baseline proteinuria was higher in the MMF group （（2.1±0.9） g/24 h） than in the control group （（1.6±0.8） g/24 h） （P=0.039）. The proteinuria decreased sig- nificantly in all groups during follow-up, but only in the MMF group did it decrease significantly after the first month. At the end of follow-up, the proteinuria was （0.4±0.7） g/24 h in the MMF group and （0.4±0.4） g/24 h in the CS group, significantly lower than that in the control group （（0.9±1.1） g/24 h）. The remission rates in the MMF group, CS group, and control group were respectively 72.7%, 71.0%, and 48.4% at six months and 72.7%, 64.5%, and 45.2% at the end of follow-up. The overall number of reported adverse events was 17 in the MMF group, 30 in the CS group, and 6 in the control group （P〈0.001）. Conclusions： MMF with low-dose prednisone may be as effective as full-dose prednisone and tend to have fewer adverse events. Therefore, it is probably superior to conservative treatments of adult HSP patients with moderate proteinuria.
文摘This study investigated the relationship between angiotensin-converting enzyme (ACE) gene insertion/deletion polymorphism and the occurrence, severity, prognosis of HSPN. The polymorphism of ACE gene in 103 HSPN cases and 100 healthy children was studied by using the polymerase chain reactions (PCR). Its relation to the clinical manifestation, pathological classification and prognosis of HSPN was analyzed accordingly. The results showed that: (1) there was a significantly higher frequency for DD genotype in HSPN children (P<0.01); (2) DD genotype was more frequently seen in HSPN children with gross hematuria and massive proteinuria (P<0.05), while DI genotype was more common in HSPN children group with renal insufficiency (P<0.05); (3) although mesangial proliferative lesion was most frequently observed in 21 biopsied HSPN children, and DD genotype frequency was still higher in children with severe pathology (Class Ⅲ Ⅳ); (4)II genotype was significantly frequent in HSPN children with complete remission in the follow-up of 32 HSPN children. It was concluded that the deletion allele of ACE gene might play a role, at least to some extent, in the occurrence, deterioration and progression in juvenile HSPN.
基金the Hospital of No.80 Group Army Institutional Review Board(Approval No.63).
文摘BACKGROUND Idiopathic membranous nephropathy(IMN)has a high incidence in the middleaged and elderly population,and poses a great threat to the physical and mental health and quality of life of patients.Nephritis Rehabilitation Tablets have many potential effects,such as clearing residual toxins,tumefying the kidney and spleen,replenishing qi,and nourishing yin,and have played an important role in the treatment of a variety of kidney diseases.AIM To investigate the efficacy and safety of Nephritis Rehabilitation Tablets combined with tacrolimus in the treatment of IMN.METHODS Eighty-four patients with IMN recruited from January 2017 to September 2020 were randomly divided into a study group(n=42)and a control group(n=42).On the basis of routine symptomatic treatment,both groups were treated with tacrolimus,and the study group was additionally treated with Nephritis Rehabilitation Tablets.Both groups were treated for 12 wk.The therapeutic effect,the levels of renal function indexes[serum creatinine(Scr),serum albumin,and 24-h urinary protein],urinary immunoglobulin(IgG4),membrane attack complex(C5b-9),and the incidence of adverse reactions were measured before and after 12 wk of treatment.RESULTS The total effective rate in the study group was significantly higher than that of the control group.Before treatment,there was no significant difference in Scr,serum albumin,or 24 h urinary protein between the two groups.After 12 wk of treatment,the levels of Scr and 24-h urinary protein in both groups were significantly lower and serum albumin was significantly higher than those before treatment(P<0.05),and the levels of Scr and 24-h urinary protein were significantly lower(P=0.003 and 0.000,respectively),and the level of serum albumin was significantly higher(P=0.00)in the study group than in the control group.Before treatment,there was no significant difference in urinary IgG4 and C5b-9 levels between the study group and the control group(P=0.336 and 0.438,respectively).After 12 wk of treatment,the levels of urinary IgG4 and C5b-9 in the two groups were lower than those before treatment,and the levels of urinary IgG4 and C5b-9 in the study group were significantly lower than those in the control group(P=0.000).There was no significant difference in the incidence of adverse reactions between the two groups(P=0.710).CONCLUSION Based on routine intervention,Nephritis Rehabilitation Tablets combined with tacrolimus in the treatment of IMN can effectively improve the renal function of patients and downregulate the expression of urinary IgG4 and C5b-9.In addition,they can improve the overall therapeutic effect while not increasing the risk of adverse reactions.
基金Supported by Department of Education of Guangdong Province:Study of Biomarkers Discovery for Patients with Relapsed Lupus Nephritis from the Perspective of Urinary Exosomal Microrna and Analysis of the Correlation with Pathogenic Dampness(2018KQNCX051)Guangdong Provincial Hospital of Traditional Chinese Medicine:Study of Biomarkers Discovery for Patients with Relapsed Lupus Nephritis from the Perspective of Urinary Exosomal Microrna and Analysis of the Correlation with Pathogenic Dampness(YN2019QL19)State Key Laboratory of Dampness Syndrome of Chinese Medicine:Early Warning and Intervention(SZ2021ZZ3204)。
文摘OBJECTIVE:To investigate the effectiveness and safety of tripterygium glycosides(TG)tablet(雷公藤多苷片)for the treatment of Lupus nephritis(LN).METHODS:Several databases were systematically searched including Pub Med,Embase,Cochrane,Wiley,China National Knowledge Infrastructure Database,Sino Med and Wanfang Library till June 20,2020.Revman5.3 was utilized to analyze the data according to the Preferred Reporting Items for Systematic Reviews and Meta-Analyses Statement.RESULTS:In total,8 randomized controlled trials involving 583 participants were identified.Meta-analyses showed that,compared with glucocorticoids(GC)alone,the combination with TG tablet provided a statistically significant improvement in total remission(TR)(RR=1.27,95%CI:1.08–1.50,P=0.004),complete remission(CR)(RR=1.61,95%CI:1.05–2.47,P=0.03)and C3 levels(WMD=0.27,95%CI:0.14–0.39,P<0.0001),C4 levels(WMD=0.12,95%CI:0.07–0.17,P<0.00001).No significant differences were seen in TR,CR,proteinuria,serum creatinine,C3 and C4(TR:RR=1.00,95%CI:0.87–1.16,P=0.95;CR:RR=1.10,95%CI:0.78–1.56,P=0.58;proteinuria levels:WMD=-0.06,95%CI:-0.13 to 0.01,P=0.10;serum creatinine levels:WMD=-0.01,95%CI:-7.36 to 7.35,P=1.00;C3 levels:WMD=0.01,95%CI:-0.06 to 0.07,P=0.84;C4 levels:WMD=-0.01,95%CI:-0.03 to 0.01,P=0.49)between azathioprine(AZA)/leflomit(LEF)+GC and TG tablet+GC.Adverse events(hepatic dysfunction,nausea,vomitting)showed no statistical differences between the TG tablet+GC group and the GC group.There were more new onset of irregular menstruation in the TG tablet+GC group than those in the AZA+GC(RR=3.57,95%CI:1.40–9.11,P=0.008)/LEF+GC(RR=6.69,95%CI:2.42-18.46,P=0.0002)group,but leucopenia lower than those in AZA+GC group(RR=0.38,95%CI:0.17-0.85,P=0.02)and alopecia(RR=0.14,95%CI:0.03-0.77,P=0.02)and rash(RR=0.09,95%CI:0.01-0.69,P=0.02)lower than those in LEF+GC group.Conclusions:This review indicates that TG tablet maybe effective in LN treatment.Nevertheless,adverse events cannot be ignored.Large sample,multi-center,highquality clinical studies are needed to verify the exact effects and safety of TG tablet in treatment of LN.
文摘BACKGROUND Purpura nephritis,also called Henoch-Schönlein purpura nephritis,is a systemic disease with small dead vasculitis as the main pathological change.AIM To observe the influence of transitional nursing activities on the compliance behaviors and disease knowledge of children with purpura nephritis.METHODS A total of 82 children with purpura nephritis were included and divided into a general nursing group(41 children)and transitional nursing group(41 children)using the envelope method.The general nursing group received routine nursing care,while the transitional nursing group received transitional nursing care.The behaviors,knowledge of the disease,and self-management ability of the two groups were evaluated after nursing care was provided.RESULTS The scores of four items(self-care ability,self-responsibility,health knowledge level,and self-concept)in the transitional nursing group were significantly higher than those in the general nursing group.CONCLUSION Transitional nursing can directly improve the disease knowledge level and selfmanagement ability of children with purpura nephritis and effectively reduce complications.
文摘The level of urinary FPA was assayed by high per formance liquid chromatography (HPLC ) in 42 normal controls, 57 cases of chronic glomeru-lonephritis, including 24 with normal renal function, 12 with renal insufficiency and 21 with uremia. Their levels were 24. 40± 10. 30 μg/L, 26. 99±5.77 μg/L,38. 81±6. 28 μg/L, 79. 74± 18. 76 μg/L, respectively. The level of urinary FPA in renal insufficiency function group was significantly higher than those of the con-trol group and normal renal function group (P<0.01). The patients with uremia presented dramatically higher level of urinary FPA than those in the renal insufficiency group (P<0.01). A positive correlation was found between the level of urinary FPA and the blood creatine (r= 0. 9120, P<0. 01 ). It was suggested that a hypercoagulable state existed in the patients with chronic nephritis with renal failure, in which the severity was closely related with the occurrence and development of the disease. The urinary FPA could serve as a good indicator for renal function.
文摘BACKGROUND Immunoglobulin G4-related disease (IgG4-RD) is an immune-mediated condition that consisted of disorders that share particular clinical,serologic and pathologic properties.The common presentation of disease includes tumor-like swelling of involved organs and the histopathological findings are a lymphoplasmacytic infiltrate enriched with IgG4-positive plasma cells,and a variable degree of fibrosis that has a characteristic "storiform" pattern in biopsy specimens of tumorlike masses.Major presentations of this disease,which often affects more than one organ,include autoimmune pancreatitis,salivary gland disease (sialadenitis),orbital disease and retroperitoneal fibrosis.The steroid treatment is essential for the treatment of the disease however,other immunosuppressive drugs including cyclophosphamide or rituximab could be an option in resistant cases.CASE SUMMARY Herein,we reported a 34-year-old woman whom previously had diagnosed with asthma,rheumatoid arthritis and Sj?gren’s syndrome (SS) referred our nephrology department due to acute kidney failure development at the last rheumatology visit.After kidney biopsy she has been diagnosed with IgG4-RD and tubuluointerstitial nephritis.She had been accepted resistant to steroid,mycophenolate mofetil,methotrexate and azathioprine therapies due to receiving in last two years.She refused to receive cyclophosphamide due to potential gonadotoxicity of the drug.Thus,rituximab therapy was considered.She received 1000 mg infusion,15 d apart and 6 mo later it has been administered same protocol.After one year from the last rituximab dose serum creatinine decreased from 4.4 mg/dL to 1.6 mg/dL,erythrocyte sedimentation rate decreased from 109 mm/h to 13 mm/h [reference range (RR) 0-20],and Creactive protein decreased from 55.6 mg/L to 5 mg/L (RR 0–6).All pathologic lymph nodes and masses were also disappeared.CONCLUSION Patients with IgG4-RD usually misdiagnosed with rheumatologic diseases including systemic lupus erythematous or SS and also they were screened for the presence of malignancy.Rituximab could be an important treatment option in cases with steroid resistant tubulointerstitial nephritis in IgG4-RD.
基金Specialized Research on Traditional Chinese Medicine in Henan Province(Grant No.KJGG108).
文摘To elucidate the mechanism underlying the therapeutic impact of Astragalus-Danshen in chronic glomerulonephritis(CGN),a comprehensive exploration was conducted utilizing network pharmacology.The TCMSP database was employed to aggregate the chemical constituents and targets associated with Astragalus and Danshen.Simultaneously,disease targets specific to CGN were sourced from the Genecards database.The convergence of these datasets yielded a set of intersection genes,representing potential targets for CGN treatment through Astragalus-Danshen formulations.Subsequently,protein interaction networks and“chemical composition-target”networks were meticulously constructed.Core targets were subjected to GO and KEGG enrichment analyses.The investigation revealed a total of 240 targets corresponding to 20 and 65 chemical components of Astragalus and Danshen,respectively.From this pool,86 potential targets associated with CGN treatment were discerned,ultimately identifying 29 core targets.Noteworthy among these were TNF,JUN,TP53,IL1B,RELA,MMP9,CASP3,IL10,MAPK14,MYC,and TGFB1.KEGG enrichment analysis illuminated pathways pertinent to CGN,encompassing the IL-17 signaling pathway,TNF signaling pathway,and the AGE-RAGE signaling pathway in diabetic complications.In summary,Astragalus-Danshen exhibited a potential anti-inflammatory and renoprotective effect on CGN,particularly through modulating the IL-17 signaling pathway,TNF signaling pathway,and AGE-RAGE signaling pathway in diabetic complications,involving key regulators such as TNF,JUN,TP53,IL1B,MAPK14,and others.
文摘Recent advances in the management of lupus nephritis, together with earlier renal biopsy and selective use of aggressive immunosuppressive therapy, have contribut-ed to a favorable outcome in children and adolescents with systemic lupus erythematosus （SLE）. Neverthe-less, we believe that a more effective and less toxic treatment is needed to attain an optimal control of the activity of lupus nephritis. Recent published papers and our experiences regarding treatment of young patients with lupus nephritis using calcineurin inhibitors are re-viewed. Although it has been reported that intermittent monthly pulses of intravenous cyclophosphamide （IVCY） are effective for preserving renal function in adult pa-tients, CPA is a potent immunosuppressive agent thatinduces severe toxicity, including myelo- and gonadal toxicity, and increases the risk of secondary malig-nancy. Thus, treatment for controlling lupus nephritis activity, especially in children and adolescents, remains challenging. Cyclosporine A （CsA） and tacrolimus （Tac） are T-cell-specific calcineurin inhibitors that prevent the activation of helper T cells, thereby inhibiting thetranscription of the early activation genes of interleu-kin （IL）-2 and suppressing T cell-induced activation of tumor necrosis factor-α, IL-1β and IL-6. Therefore, both drugs, which we believe may be less cytotoxic, are attractive therapeutic options for young patients with lupus nephritis. Recently, a multidrug regimen of prednisolone （PDN）, Tac, and mycophenolate mofetile （MMF） has been found effective and relatively safe in adult lupus nephritis. Since the mechanisms of action of MMF and Tac are probably complementary, multidrug therapy for lupus nephritis may be useful. We propose as an alternative to IVCY, a multidrug therapy with mizoribine, which acts very similarly to MMF, and Tac, which has a different mode of action, combined with PDN for pediatric-onset lupus nephritis. We also believe that a multidrug therapy including CsA and Tac may bean attractive option for young patients with SLE and lupus nephritis
