低分子肝素与黄芪联用治疗难治性肾病综合征临床研究

目的:探讨低分子肝素与黄芪注射液联用对难治性肾病综合征的治疗作用.方法:65例难治性肾病综合征患者随机分成两组,对照组进行常规治疗,治疗组在常规治疗的基础上加用低分子肝素和黄芪注射液.然后进行疗效观察,并通过实验室检查评价低分子肝素与黄芪对肾功能和凝血功能的作用.结果:两组疗效比较,治疗组明显优于对照组(P＜0.05);其血清蛋白、尿蛋白、BUN、Cr、Fg、FⅡa、FX a、AT-Ⅲa、血白细胞计数等实验室检查指标,治疗组与治疗前比较有统计学差异(P＜0.05),与对照组治疗后比较亦有统计学差异(P＜0.05),其疗效与病理类型有关.结论:低分子肝素与黄芪注射液可降低血液的高凝状态,联合应用治疗难治性肾病综合征疗效显著.     

低分子肝素联合来氟米特治疗难治性肾病综合征40例分析

笔者对2006年1月至2008年12月我科的40例难治性肾病综合征患者采用激素、低分子肝素注射液（LMWH）、来氟米特联合治疗,现报道如下。     

环磷酰胺冲击治疗难治性肾病综合征

难治性肾病综合征 (ＲＮＳ)是多病因、频复发、激素依赖和耐药及病情迁延的一种小儿常见病 ,临床治疗颇为棘手。我院自 1992年以来采用环磷酰胺 (ＣＴＸ)、强的松、保肾康联合治疗ＲＮＳ ,取得良好效果 ,现报告如下。资料与方法1　一般资料　共观察 43例 ,随机分为两组 :(1)治疗组 (加ＣＴＸ) 2 3例 ,男 15例 ,女 8例 ;年龄 <3岁 5例 ,3～ 7岁11例 ,7～ 14岁 7例。对照组 2 0例 ,男 13例 ,女 7例 ;年龄<3岁 3例 ,3～ 7岁 10例 ,7～ 14岁 7例。均为住院患儿 ,符合 1981年全国肾脏病学术会议修订的诊断标准与临床分型。两组病人中 ,单纯性肾病…     

低分子肝素治疗肾病综合征临床观察

为了观察低分子肝素对原发性肾病综合征的疗效 ,我们对完全符合肾病综合征诊断标准的患者 110例作了临床观察。资料与方法1　临床资料　该 110例患者均为我院住院或门诊病人。随机分为两组 ,治疗组 60例 ,对照组 5 0例。两组在性别、年龄及尿蛋白定量方面无明显统计学意义。对照组给予标准激素疗法及对症处理 ,观察组在上述药物治疗的基础上加用低分子肝素 (广东天普生物化学制药有限公司研究所生产 ) 5 0 0 0μ皮下注射 ,每日 2次。2　观察指标　所有病例均为每周测尿蛋白 ,测凝血酶原时间 (ＰＴ) ,部分凝血活酶时间 (ＫＰＴＴ ) ,纤维蛋白…     

霉酚酸酯联合低分-子肝素治疗难治性肾病综合征

难治性肾病综合征(NS)仍是医学上棘手的问题,虽然环磷酰胺和环孢素A的介入可能取得部分疗效,但因其严重的副作用而受到限制。我们旨在探讨新型免疫抑制剂霉酚酸酯(MMF)联合低分子肝素(LMWH)对难治性NS的临床作用。 一、对象与方法 1.治疗对象:13例住院患者均符合原发性肾病综合症的诊断标准,其中女8例,男5例,病程15-33个月,年龄17-53岁,平均(33±9)岁。13例患者均     

肾病治疗仪配合强的松与环磷酰胺治疗难治性肾病综合征

难治性肾病综合征 (ＲＮＳ)的治疗临床上甚为棘手〔1〕,为提高其疗效 ,减少复发 ,我们探讨了电脑肾病治疗仪配合常规激素、环磷酰胺治疗ＲＮＳ 48例 ,疗效满意 ,现报道如下。临床资料共观察 95例 ,系我院门诊及住院病人 ,均符合ＲＮＳ的诊断标准〔1〕。其中男性 6 5例 ,女性 30例 ;年龄 18岁～ 6 2岁 ,平均 (30 8± 10 2 )岁 ,治疗前病程 6月～ 3.5年 ,平均(10 3± 4 5 )月。其中常复发型 45例 ,激素依赖型 48例 ,激素无效型 2例。全部病例随机分成电脑肾病治疗仪治疗组 (以下简称治疗组 ) 4 8例和对照组 47例两组。两组在性别、年龄、症…     

低分子肝素治疗糖尿病肾病的临床分析

糖尿病肾病是糖尿病的严重微血管病变,是导致终末期肾功能衰竭的主要原因之一。糖尿病肾病患者血液多呈高凝状态,肾小球内凝血、血栓形成,导致肾功能衰竭进展加剧。我院应用低分子肝素治疗糖尿病肾病,改善肾小球内高凝状态,修复肾小球基底膜电荷屏障,明显延缓糖尿病肾病的病程进展。     

环磷酰胺合强的松治疗难治性肾病综合征远期疗效观察

难治性肾病综合征的治疗较为棘手。我们用环磷酰胺(ＣＴＸ)合强的松治疗难治性原发性肾病综合征 4 1例 ,现报告如下。资料与方法1　病例选择　收集 1996年～ 2 0 0 0年住院的难治性肾病综合征病人 4 1例 ,男 30例 (其中未婚男性 8例 ) ,女 11例 ;年龄 15岁～ 5 8岁。其中激素无     

环孢素A与环磷酰胺对难治性肾病综合征疗效分析比较

目的：探讨环孢素A（CsA）与环磷酰胺（CTX）对难治性肾病综合征（RNS）的疗效比较。方法：2005年3月～2009年8月难治性肾病综合征患者纳入研究,随机分为两组,使用CsA治疗的患者作为CsA治疗组,使用CTX治疗的患者作为CTX治疗组。CsA组起始剂量1.0～1.5mg/kg,血药浓度调整在100～150ng/L。CTX组1.0g/次,1次/月,累积量不超过8g。观察两组蛋白尿、血浆白蛋白、肾功能变化情况及不良副作用。结果：（1）CsA组缓解率为59.2%（42/71）,其中23.9%（17/71）完全缓解;CTX组缓解率为50%（28/56）,其中19.6%（11/56）达完全缓解。两组资料比较差异无统计学意义（χ2=4.417,P〉0.05）。（2）MN型肾病患者,本研究中CsA组总缓解率78.6%（33/42）,完全缓解率为45.2%（19/42）;CTX组总缓解率为48.5%（16/33）,完全缓解率为21.2%（7/33）。两组比较差异具有统计学意义（χ2=8.280,P〈0.05）。（3）毒副作用：CsA组血压升高9例,6例Scr上升,肝功异常4例,高尿酸血症3例,肺部感染2例,占32.4%（23/71）;CTX组6例肝功能异常,4例白细胞减少,7例出现消化道不适症状（4例合并肝功能异常）,1例血尿,总共占32.1%（18/56）。结论：CsA与CTX对RNS患者的疗效总体无明显差别,但对MN,CsA疗效可能优于CTX,但维持时间及维持剂量仍需进一步研究。     

环孢素A联合激素治疗难治性肾病综合征31例临床疗效观察

目的 探讨环孢素A（cyclosporine-A,CsA）联合激素治疗难治性肾病综合征的临床疗效及安全性.方法 对31例难治性肾病综合征患者使用糖皮质激素联合CsA治疗：CsA起始剂量平均（1.57±0.25）mg·kg^-1 ·d^-1,泼尼松起始剂量平均（0.69±0.20）mg· kg^-1·d^-1,分别测定CsA治疗前及治疗后1、3、6个月患者的24 h尿蛋白定量、肝功能[丙氨酸氨基转移酶（glutamate-pyruvate transaminase,AST）、天冬胺酸氨基转移酶（glutamic oxalacetic transaminase,ALT）、血浆白蛋白（serum albumin,Alb）]、肾功能[血肌酐（serum creatinine,SCr）、血尿酸（uric acid,UA）]、血常规[白细胞（white blood corpuscle,WBC）、血红蛋白（hemoglobin,Hb）、血小板（blood platelet,PLT）]及环孢素血药浓度等指标的变化,并记录不良反应.结果 加用CsA治疗后患者各项指标均较治疗前明显好转,治疗3个月时24 h尿蛋白定量由治疗前的（5.56±2.13）g降至（1.37±1.41） g（P＜0.05）,血浆白蛋白由（24.80±4.69） g/L升至（37.5±5.03） g/L（P＜0.05）,完全缓解9例,部分缓解12例,缓解率67.7％;治疗6个月时24 h尿蛋白定量由治疗前的（5.56±2.13）g降至（0.83±1.21）g（P＜0.05）,血浆白蛋白由（24.80±4.69） g/L升至（41.08±5.64） g/L（P＜0.05）,完全缓解16例,部分缓解11例,无效4例,缓解率87.1％,治疗前后结果差异有统计学意义（P＜0.05）.结论 CsA联合激素治疗可显著减少肾病综合征患者的尿蛋白,且不良反应少,可用于难治性肾病综合征的治疗.     

他克莫司治疗难治性肾病综合征的新进展

难治性肾病综合征约占原发性肾病综合征的30%～50%,包括激素依赖型、激素抵抗型和频复发型,具有病程长、易复发等特点。若得不到合理治疗可导致疾病难以缓解,并可能出现严重并发症,甚至进展为不可逆性慢性肾衰竭,极大影响患者生存质量,并威胁生命。目前,难治性肾病综合征患者多加用免疫抑制剂治疗,以糖皮质激素联合烷化剂较为经典,但其潜在的性腺毒性、骨髓抑制及致癌等不良反应限制了临床应用。近年,国内外应用新型免疫抑制剂他克莫司在治疗难治性肾病综合征中取得了较好疗效,本文就他克莫司治疗难治性肾病综合征的疗效及安全性方面的新进展做一综述。     

Lack of efficacy of low molecular weight heparin in a boy with congenital nephrotic syndrome

SUMMARY: The congenital nephrotic syndrome (CNS) is characterized by severe proteinuria, followed by hypoalbuminaemia and hypercoagulopathy. the boy was born in the 39th gestational week (1980 g bodyweight). In the first days of his life, he developed proteinuria and oedema, and on the 10th day, a thrombosis of the vena cava inferior was diagnosed. the boy was treated with unfractionated heparin, antithrombin concentrates and a low-dose of recombinant tissue plasminogen activator (rtPA). After 2 days, a complete resolution of the thrombus was observed. Treatment with unfractionated heparin and antithrombin III was continued. At the age of 3 months, low molecular weight heparin (LMWH) was started before the patient was discharged. Despite a high dose of LMWH, 250 IU/kg bodyweight, the anti-Xa-activity was always below 0.1 U/mL. Therefore, anticoagulation was achieved by the administration of vitamin K antagonist. Low molecular weight heparin is bound to albumin and antithrombin. Therefore, the renal loss of these proteins may result in low plasma levels of LMWH, and may not be effective in patients with CNS.     

Efficacy of leflunomide combined with prednisone in the treatment of refractory nephrotic syndrome

Objective: To assess the safety and clinical efficacy of leflunomide (LEF) and prednisone on refractory nephrotic syndrome (RNS).

Methods: A total of 52 patients with RNS were treated for 24 weeks between 2010 and 2014 in our hospital. In the treated group, 26 patients were treated with LEF and prednisone, and, in the control group, 26 patients were treated with cyclophosphamide (CTX) and prednisone. During the treatment, 24?h urinary protein excretion and the serum levels of albumin and cholesterol, and kidney function were assayed before and after the therapy. Adverse reactions during treatment were recorded.

Results: In the LEF group, the medication was markedly effective in eight cases and effective in nine cases; the total efficacy rate was 65.30%. In the CTX group, the treatment was markedly effective in six cases and effective in nine cases; the total efficacy rate was 57%. There were no significant differences between the results of the total efficacy rate (p?>?.05). The 24?h urinary protein excretion and serum cholesterol levels in both groups decreased after therapy and the serum levels of albumin in both groups increased after therapy. There were significant differences between the results for the 24?h urinary protein excretion, serum levels of albumin and cholesterol in the two groups (p?<?.05). The treatments were well tolerated in both groups.

Conclusion: LEF combined with prednisone has a certain efficacy on the RNS and displays few adverse reactions. A large-sample, randomized double-blind controlled study and long-term follow-up are needed to verify the efficacy of LEF combined with prednisone.     

来氟米特及雷公藤多甙联合泼尼松治疗难治性肾病综合征

难治性肾病综合征治疗方案的研究是肾脏疾病临床工作的重要内容。我院采用来氟米特及雷公藤多甙联合泼尼松治疗难治性肾病综合征，取得良好的效果，现报道如下。     

Thyroid hormone replacement for nephrotic syndrome patients with euthyroid sick syndrome: a meta-analysis

Objective: To assess the efficacy of thyroid hormone replacement therapy for nephrotic syndrome (NS) patients associated with euthyroid sick syndrome (ESS). Materials and methods: The Cochrane library, ISI, Ovid, PubMed, Chinese Biomedicine Database were searched, and reference list of relevant articles were selected. Randomized controlled trials (RCTs) or quasi-RCTs with thyroid hormone replacement on NS patients associated with ESS were included in this analysis. Results: Six trials (329 participants) were included. Meta-analysis showed that thyroid hormone replacement therapy can significantly increase the completely remission rate [OR?=?3.04, 95% confidence interval (CI): 3.04–1.88, p?p?Conclusions: Thyroid hormone replacement therapy significantly increases the remission of ESS in patients with NS.     

Survey of rituximab treatment for childhood-onset refractory nephrotic syndrome

Background

Rituximab (RTX) is a promising option for treating childhood-onset steroid-dependent (SDNS), frequently relapsing (FRNS), and steroid-resistant (SRNS) nephrotic syndrome.

Methods

We retrospectively surveyed RTX treatment for these conditions to evaluate its indications, efficacy and adverse events. Questionnaires were sent to 141 hospitals in Japan.

Results

Seventy-four patients (52 SDNS; 3 FRNS; 19 SRNS) were treated with RTX because of resistance to various immunosuppressive agents. Most patients received a single administration of RTX (85%). Forty-one of 53 SDNS/FRNS (77%) and 5 of 17 SRNS (29%) patients successfully discontinued prednisolone (16 SDNS/FRNS and 6 SRNS achieved their first discontinuation since onset), and 17 out of 53 SDNS/FRNS patients (31%) discontinued cyclosporine. However, 28 of the 53 patients (51%) relapsed. Although immunosuppressive agents did not extend B cell depletion, relapses were significantly less if immunosuppressive agents were continued after RTX (P?=?0.006; hazard ratio?=?0.2). Among the SRNS patients, complete (n?=?6) and partial remission (n?=?6) were achieved. No life-threatening adverse events were experienced.

Conclusions

Although this was a multi-center survey where treatment of nephrotic syndrome varied between centers, the steroid-sparing effect of RTX in SDNS/FRNS was excellent. If single administration of RTX is chosen, continuation of immunosuppressive agents is recommended for prevention of relapse.     

Steroid-dependent nephrotic syndrome and cyclophosphamide

Sir, I read with great interest in a recent issue the article byDonia et al. [1] about intravenous (i.v.) cyclophosphamide (CP)in steroid-dependent nephrotic syndrome (SDNS) patients. Theresults of this study