来氟米特联合糖皮质激素治疗IgA肾病的临床研究

目的 观察应用来氟米特（Leflunomide,LEF）联合激素治疗IgA肾病的疗效和安全性.方法 选择IgA肾病患者63例,分为LEF合并激素治疗组（LEF组）及大剂量激素治疗组（激素组）,观察治疗前和治疗6个月、12个月后的24 h尿蛋白定量、血清白蛋白、肾小球率过滤（eGFR）、收缩压、舒张压等实验室指标的变化,并进行疗效评价.结果 LEF组和激素组治疗6个月和12个月后的24 h尿蛋白定量、收缩压、舒张压均较治疗前显著下降（P＜0.05）,血清白蛋白水平较治疗前显著升高（P＜0.05）,2组eGFR变化均无统计学差异（P＞0.05）.治疗12个月后LEF组的总有效率明显高于激素组（P＜0.05）,而完全缓解率和部分缓解率的差异无统计学意义（P＞0.05）,2组不良反应无显著性差异（P＞0.05）.结论 LEF联合激素可以作为治疗IgA肾病的选择之一,且安全、有效.     

激素联合来氟米特或环磷酰胺治疗慢性进展性IgA肾病的比较

目的：比较激素联合环磷酰胺（CTX）或来氟米特 （LEF）治疗慢性进展性IgA肾病（IgAN）的疗效及安全性.方法：回顾性分析2009年6月~2012年7月在我院确诊为IgAN患者,Lee氏分级Ⅱ级或以上,并应用激素分别联合CTX或LEF治疗的患者57例,CTX组25例,LEF组32例;收集患者治疗前及每月随访资料.结果：经治疗IgAN尿蛋白总缓解率达87.7%,治疗期间CTX组和LEF组尿蛋白部分缓解分别为7例（28.0%）和11例（34.4%）,P=0.607;CTX组和LEF组尿蛋白完全缓解分别为14例（56.0%）和18例（56.2%）,P=0.985.CTX组和LEF组部分缓解时间分别为（2.95±1.70）月和 （3.27±3.01）月,差异有统计学意义（P=0.048）,CTX组和LEF组尿蛋白完全缓解时间分别为（5.45±3.31）月和（6.69±5.82）月,P=0.052.随访中CTX组副反应发生率12.0%,LEF组副反应发生率6.25%.结论：激素联合CTX或LEF治疗慢性进展性IgAN均有相同的疗效,CTX组部分缓解时间较LEF快,长期疗效及安全性有待进一步观察.     

雷公藤多苷联合小剂量糖皮质激素对IgA肾病伴肾功能减退患者的疗效观察

目的：观察雷公藤多苷联合小剂量糖皮质激素（简称激素）较单用激素治疗IgA肾病伴肾功能减退患者的临床疗效和安全性。方法：56例经肾活检证实且伴肾功能轻中度减退（肾小球率过滤50~80 ml/min）的IgA肾病患者分成两组。雷公藤组应用雷公藤多苷联合小剂量激素治疗,激素组为常规激素治疗,观察治疗0、3、6、9和12个月的蛋白尿、肾功能等临床指标变化,并评价不良反应。结果：激素组治疗9个月时24 h尿蛋白定量较治疗前开始减少（P＜0.05）,雷公藤组治疗6个月时开始减少（P＜0.05）。12个月时,激素组由治疗前（2.12±0.81）g降至（0.99±0.59）g,P＜0.01;雷公藤组由（2.21±0.75）g降至（0.43±0.18）g,P ＜0.01。治疗9、12个月时,雷公藤组24 h尿蛋白定量较激素组降低显著（P＜0.05）。与治疗前比较,激素组治疗6个月时,肾功能开始下降,表现为Scr升高（P＜0.01）,内生肌酐清除率（Ccr）下降（P＜0.01）。雷公藤组9个月时开始下降,Scr升高（P ＜0.01）,Ccr下降（P＜0.01）。两组间治疗后3、6、9个月疗效比较,Scr以及Ccr的变化差异均无统计学意义（P〉0.05）,12个月时,雷公藤组肾功能优于激素组（P＜0.05）。治疗期间激素组3例（10%）出现柯兴貌、面部痤疮,雷公藤组1例出现白细胞轻度减少。结论：雷公藤多苷联合小剂量激素能有效减少伴肾功能减退IgA肾病的蛋白尿,且一定程度上延缓肾功能进展,耐受性好。长期疗效仍需继续随访。     

来氟米特与霉酚酸酯治疗表现为肾病综合征的过敏紫癜性肾炎的疗效比较

目的：比较来氟米特（LEF）与霉酚酸酯（MMF）治疗临床表现为肾病综合征的过敏紫癜性肾炎（HSPN）的临床疗效。方法：36例临床表现为肾病综合征的HSPN患者,分别采用激素联合LEF治疗（LEF组,n=18）,或采用激素联合MMF治疗（MMF组,n=18）。LEF或MMF正规使用6个月以上。收集治疗前及治疗6个月以后的血尿常规、尿红细胞计数、24h尿蛋白定量、肝肾功能、白蛋白及血脂等指标,同时记录不良反应。结果：（1）两组接受治疗后,尿蛋白和尿红细胞计数均明显减少（P〈0.01）,血白蛋白明显上升（P〈0.01）。（2）临床缓解率：LEF组总有效率为83.3%,MMF组总有效率为88.8%,两组之间无统计学差异;其中完全缓解率分别为50.0%和44.4%,部分缓解率分别为33.3%和44.4%,均无统计学差异（P〉0.05）。（3）两组患者均耐受良好,无明显副作用。结论：LEF和MMF联合激素治疗表现为肾病综合征的HSPN的临床缓解率相似,不良反应轻微。     

吗替麦考酚酯联合糖皮质激素治疗激素抵抗特发性膜增殖性肾小球肾炎

目的 观察吗替麦考酚酯（MMF）联合糖皮质激素治疗激素抵抗特发性膜增殖性肾小球肾炎（IMPGN）的临床疗效。 方法 共13例患者，经肾穿刺活检诊断为MPGN，并排除继发性因素，明确诊断为IMPGN，其中4例中等量蛋白尿、9例大量蛋白尿、9例高血压、11例肾功能不全。在MMF治疗前，均经过足量糖皮质激素治疗（每日泼尼松1 mg/kg）至少8周，尿蛋白均无明显下降。随后泼尼松在8周内减量至每日0.5 mg/kg，同时加用MMF 1.5 g/d。 结果 13例患者在泼尼松治疗前尿蛋白量（24 h）为（4.1±1.4） g；Scr为（131.0±44.9） μmol/L；MDRD公式估算肾小球滤过率（eGFR）（63.2±26.8） ml·min-1·（1.73 m2）-1。接受足量泼尼松治疗8周后，尿蛋白量（24 h）为（4.2±1.5） g；Scr为（133.2±52.8） μmol /L；eGFR为（63.3±27.1） ml·min-1·（1.73 m2）-1；差异均无统计学意义。加用MMF治疗3个月后，尿蛋白量（24 h）轻微减少，为（3.8±1.2） g；Scr为（127.3±43.7） μmol/L；eGFR为（65.7±26.8） ml·min-1·（1.73 m2）-1，差异亦均无统计学意义。MMF治疗6个月后，尿蛋白量（24 h）显著下降至（2.5±0.9） g（P < 0.05）；Scr为（109.5±31.0） μmol/L（P < 0.05）；eGFR为（72.9±25.3） ml·min-1·（1.73 m2）-1（P < 0.05）。MMF治疗12个月后，尿蛋白量（24 h）为（1.5±0.6） g（P < 0.01) ，13例均达到部分缓解（尿蛋白量下降>50%）；Scr为（95.9±22.5） μmol/L（P < 0.01）；eGFR为（81.2±23.8） ml·min-1·（1.73 m2）-1（P < 0.01）。治疗过程中仅1例出现轻微的胃肠道症状。 结论 MMF联合糖皮质激素治疗激素抵抗IMPGN能明显减少蛋白尿，改善肾功能，无明显不良反应。     

肾炎康复片联合来氟米特治疗尿检异常型IgA肾病的临床研究

目的：观察肾炎康复片联合来氟米特治疗尿检异常型IgA肾病的临床疗效和安全性。方法：将90例尿检异常型IgA肾病患者,随机分为治疗组45例和对照组45例。治疗组肾炎康复片联合来氟米特治疗,对照组单纯应用来氟米特,观察时间均为12月。试验中监测治疗前和治疗后3个月、6个月和12个月的尿沉渣红细胞计数（尿RBC计数）、24h尿蛋白定量、血浆白蛋白（Alb）、肝肾功能和全血细胞计数的变化以及药物治疗的副作用。结果：与实验开始时相比,治疗组在治疗第3个月时即表现出明显的疗效,尿RBC计数与尿蛋白定量明显下降（P〈0.01）;随着疗程的延长,治疗组患者尿检进一步改善。而对照组治疗3个月及6个月后尿RBC计数、尿蛋白定量与治疗前相比无统计学差异（P〉0.05）,仅治疗12个月后才明显下降（P〈0.05）。两组间同期相比均有统计学差异（P〈0.01）。不良反应治疗组无1例发生,对照组发生3例（6.6%）。结论：肾炎康复片联合来氟米特治疗尿检异常型IgA肾病疗效显著,与单用来氟米特相比可有效减少尿蛋白和镜下血尿,且耐受性较好。     

肾脏病理高积分的少量蛋白尿IgA肾病激素治疗疗效观察

目的：观察肾脏病理高积分的少量蛋白尿IgA肾病患者给予激素治疗的疗效。方法：45例少量蛋白尿IgA肾病患者随机分为两组,所有患者病例积分Haas分型≥Ⅱ型、Katafuehi积分肾小球损伤积分≥2分和（或）肾小管间质损伤积分≥2分,治疗组（22例）给予激素和常规治疗,对照组（23例）仅给予常规治疗。结果：治疗组尿蛋白量显著减少[（0．48±0．17）g／24hvs（0．93±0．36）g／24h,P〈0．05];中等量蛋白尿、eGFR下降终点事件发生率显著低（P〈0．05）。结论：以肾脏病理积分作为少量蛋白尿IgA肾病的指导依据可以获得更好临床预后。     

来氟米特与雷公藤多苷及单纯激素治疗IgA肾病的疗效观察

目的：了解来氟米特（LEF）、雷公藤多苷联合激素,以及单纯激素治疗IgA肾病的疗效。方法：回顾性分析不同方法治疗的中等量蛋白尿IgA肾病患者61例,其中来氟米特联合中等量激素（LEF组）21例,雷公藤多苷联合中等量激素（雷公藤多苷组）24例,单纯常规量激素治疗组16例。观察用药期间24h尿蛋白定量、血尿素氮、血肌酐、血常规、血胆固醇、血清白蛋白、肝功能的变化,同时记录不良反应。结果：治疗24周后,LEF组的完全缓解率及总有效率分别为31.6%和84.2%,雷公藤多苷组的完全缓解率及总有效率分别为46.7%和86.7%,单纯激素组的完全缓解率及总有效率分别为46.7%和73.3%,3组疗效差异无统计学意义。治疗期间单纯激素组的复发率为20%,其他两组均为0,单纯激素治疗组复发率与LEF组、雷公藤多苷组相比差异有统计学意义。LEF组、雷公藤多苷组、单纯激素组的不良反应发生率分别为14.2%、37.5%、12.5%,雷公藤多苷组不良反应的发生率较其他两组显著高,差异有统计学意义。结论：LEF、雷公藤多苷联合激素和单纯激素治疗IgA肾病的近期疗效相似,但单纯激素治疗复发率高,雷公藤多苷治疗不良反应发生率高。3种治疗方法的长期疗效和安全性有待于进一步观察。     

来氟米特与环磷酰胺治疗膜性肾病的疗效比较

目的：评价来氟米特（LEF）与环磷酰胺（CTX）分别联合泼尼松（PED）治疗成年人特发性膜性肾病（IMN）的疗效及安全性。方法：80例原发性肾病综合征患者经肾活检确诊为IMN,在诊断上排除了继发性膜性肾病,随机分两组：LEF组40例采用LEF＋PED治疗,CTX组40例采用CTX＋PED治疗。治疗期间及治疗前后,监测血常规、尿常规、24h尿蛋白定量、血白蛋白、血脂、肝肾功能,6个月后行疗效和安全性的评价。结果：（1）LEF组40例中失访1例,完成6个月治疗39例。CTX组40例中因不耐受药物不良反应中途退出7例,完成6个月治疗33例;（2）治疗3个月后LEF组的完全缓解率显著低于CTX组（χ2=4.3516,P〈0.05）,LEF组的未缓解显著高于CTX组（χ2=4.9059,P〈0.05）;治疗6个月后两组的完全缓解率、未缓解率差异无统计学意义（P均〉0.05）;（3）治疗6个月后,两组患者的24hUpro、Alb、TC、TG均较治疗前显著改善（LEF组：t=7.0841,9.0998,8.4412,7.7942;CTX组：t=8.7823,9.2826,7.1252,6.9731,P均〈0.01）,CTX组的改善略微优于LEF组（t=1.8112,1.6780,0.9881,1.6778,P均〉0.05）,但差异均无统计学意义;（4）CTX组中因不良反应中途退出的比率（7/40）显著高于LEF组（0/40）,（χ2=5.6360,P〈0.05）;LEF组不良反应发生率（5/39）显著低于CTX组（13/40）,（χ2=4.3468,P〈0.05）,差异均有统计学意义。结论：来氟米特治疗膜性肾病,与环磷酰胺的临床疗效相似,不良反应较少,但起效稍慢。     

进展性IgA肾病患者血清IL-18水平及来氟米特对其的影响

目的：观察进展性IgAN患者的血清白细胞介素-18（IL-18）水平,及来氟米特（LEF）治疗前后对其的影响。方法：将进展性IgAN患者随机分为来氟米特（LEF）组和激素组,使用酶联免疫吸附法（ELISA）检测其治疗前后的血清IL-18水平。结果：共36例患者完成为期12个月的随访,来氟米特联合激素治疗后可使蛋白尿水平显著降低,肾功能维持稳定。患者治疗前血清IL-18水平较对照组显著升高[（360.3±25.2）vs（51.2±8.9）ng/L,P〈0.01],治疗显效者其水平显著降低。Logistic回归显示治疗前血清IL-18水平是预测进展性IgAN患者疗效的独立危险因素（β=-0.582,P=0.001）。结论：来氟米特可作为进展性IgA肾病的有效治疗方案,治疗前IL-18可能成为IgAN发病预测、疗效预判的一个无创指标。     

The treatment of tacrolimus in primary IgA nephropathy with mild or moderate renal injury: a randomized controlled study

Objective To investigate the efficacy and safety of immunosuppressive therapy (Tacrolimus or CTX) in primary IgA nephropathy (IgAN) with mild or moderate renal dysfunction. Methods Thirty-six primary IgAN patients diagnosed by renal biopsy, with mild or moderate renal dysfunction[30 ml•min-1•(1.73m2)-1≤eGFR＜90 ml•min-1•(1.73m2)-1, proteinuria＞1.0 g/24 h] were recruited in this randomized controlled trial. All the patients were assigned into steroid therapy alone, steroid combined with CTX (CTX group) and steroid combined with tacrolimus (tacrolimus group). Results The 24-hour proteinuria at baseline were (1.91±0.81) g/24 h, (2.42±1.46) g/24 h, (2.57±1.87) g/24 h in steroid group, CTX group and tacrolimus group respectively. Compared with baseline, it was significantly decreased in steroid group at 3 months [(0.90±0.75) g/24 h, P＜0.05], 6 months [(0.76±0.73) g/24 h, P＜0.05] and 12 months [(0.35±0.35) g/24 h, P＜0.05], in CTX group at 3 months [(1.40±1.24) g/24 h, P＜0.05], 6 months [(0.87±0.83) g/24 h, P＜0.05] and 12 months [(0.68±0.70) g/24 h, P＜0.05], and in FK506 group at 3 months [(1.10±1.33) g/24 h, P＜0.05], 6 months [(0.78±0.69) g/24 h, P＜0.05] and 12 months [(0.69±0.82) g/24 h, P＜0.05]. At 6 months, serum creatinine were decreased in steroid alone [(111.72±31.23) μmol/L vs (121.17±36.51) μmol/L, P＜0.05] and in CTX group [(111.33±22.76) μmol/L vs (124.33±35.51) μmol/L, P＜0.05], while no significant difference was detected in tacrolimus group. At 12 months, there was no significant difference in terms of serum creatinine in all three groups. Besides, there was no significant difference in terms of eGFR (CKD-EPI) in all three groups. One case presented hyperglycemia and one case had liver dysfunction during the treatment in steroid group. Two cases had hyperglycemia, one case had impaired glucose tolerance and one case had liver dysfunction in the tacrolimus group. Conclusions Steroid along, steroid combined with tacrolimus or combined with CTX are efficient in reducing urine protein in the treatment of primary IgAN with mild or moderate renal dysfunction without inducing increased serum creatinine. Given the occurrence of hyperglycemia during the treatment with steroid combined with tacrolimus, it is important to monitor tacrolimus concentration during the treatment.     

Peritubular capillaries injury and its association with clinical characteristics and long term renal survival in primary malignant nephrosclerosis patients

Objective To analyze the clinic-pathological data and peritubular capillary (PTC) injuries of malignant nephrosclerosis (MN) patients and their correlations with the long term renal survival. Methods This was a retrospective cohort study of 52 MN patients in Peking Union Medical College Hospital from January 2003 to March 2012. Their clinical data and renal biopsy samples were carefully studied. CD34 staining was performed to evaluate the PTC area, using Benign nephrosclerosis (BN, n=17) patients and glomerular minimal lesions (GML, n=19) patients as controls. Multivariate Cox proportional hazard model was used to identify the potential independent risk factors for long term renal survival. Results Fifty-two MN patients were enrolled. The sex ratio of male to female was 12∶1 and the average age was (34.0±8.2) years. The maximum blood pressure (SBP/DBP) was (230.4±25.0)/(156.4±20.6) mmHg, companied with significant loss of eGFR and proteinuria. Glomerular sclerosis index, tubular atrophy and interstitial fibrosis correlated with eGFR and proteinuria(P＜0.05). After aggressive treatment, BP control rate improved significantly (76.9% vs 3.7%, P＜0.01), Scr [(376.4±263.8) μmol/L vs (486.8±375.7) μmol/L, Wilcoxon test, P＜0.01] and proteinuria [(1.10±0.70) g/24 h vs (2.04±1.26) g/24 h, P＜0.01, n=21] also improved. PTC area in MN patients was significantly lower than those in BN patients and GML patients, and it correlated well with Scr (r=-0.553, P=0.001) and eGFR (r=0.476, P=0.004). The median follow-up time was 74 months, the cumulative renal survival rate at 1 year, 5 year and 10 year was 90%, 64% and 23%, respectively. Kaplan-Meier analysis showed that the patients with higher PTC area had longer renal survival time [(114.8±12.4) months vs (63.0±8.3) months, χ2=5.312, P＜0.05]. Univariate Cox proportional hazard model found that unsatisfied BP control, eGFR＜30 ml?min-1?(1.73 m2)-1 upon discharge, lower PTC area, severer tubular-interstitial damage and anemia were associated with poor renal outcome. Multivariate Cox model showed that unsatisfied BP control (RR=3.89, 95% CI 1.75-8.65, P=0.001), eGFR＜30 ml?min-1?(1.73 m2)-1 upon discharge (RR=4.27, 95%CI 1.40-13.09, P=0.011) were independent risk factors for long-term renal survival. Conclusions The correlation between PTC area and renal functions in MN patients are much better than that of classic vascular changes. Unsatisfied BP control and eGFR＜30 ml?min-1?(1.73 m2)-1 upon discharge are independent risk factors for long-term renal survival.     

Effect of urate-lowering therapy on renal function in chronic kidney disease stages 2-5

Objective To investigate the effect of urate-lowering therapy on renal function in chronic kidney disease (CKD) stages 2-5 patients with hyperuricemia (HUA). Methods A total of 132 patients of CKD stages 2-5 with HUA between July 2016 and December 2017 in Department of Nephrology of the Second Affiliated Hospital of Anhui Medical University were prospectively and self-controlled analyzed. Serum uric acid (SUA), estimated glomerular filtration rate (eGFR) and other clinical parameters were measured at baseline and after 1-6 months treatment. The patients were divided into group A (CKD stages 2-3a) and group B (CKD stages 3b-5) on the baseline value of eGFR. The changes of SUA and eGFR before and after treatment were compared. According to the level of SUA after 6 months treatment, patients were divided into attainment group (SUA＜360 μmol/L) and nonattainment group (SUA≥360 μmol/L). The difference of renal function in pre-treatment and post-treatment was compared. Multiple stepwise linear regression was used to analyze the relationship among the change of eGFR after receiving 6 months' treatment (deGFR) and SUA level, baseline eGFR and other indexes. Results After 1, 3, 6 months treatment, the average levels of SUA, Scr and urea nitrogen of all patients were decreased significantly while eGFR value was increased significantly (all P＜0.050) than those in pre-treatment period. After six-month-therapy, proteinuria and hematuria were improved significantly in all patients (P＜0.001, P=0.001). Compared with pre-treatment period, both the SUA levels of group A and group B were declined significantly while eGFR had a significant rise after treatment (P＜0.001). The change of eGFR post-treatment in group A was significantly higher than that of group B [(13.64±15.35) vs (8.97±9.79) ml?min-1?(1.73 m2)-1, P=0.044]. At 6 months after treatment, the eGFR value increased markedly in both attainment group and nonattainment group compared with pre-treatment period (P＜0.001). After six-month-therapy, the eGFR value in attainment group was increased more obviously than that of nonattainment group [(13.96±14.64) vs (8.03±9.69) ml?min-1?(1.73 m2)-1, P=0.021]. Multiple stepwise linear regression analysis showed that the baseline eGFR value was an influencing factor of deGFR (b=0.161, P=0.020). Conclusions The renal function of CKD stages 2-5 patients with HUA can be significantly improved by urate-lowering therapy, which can effectively reduce proteinuria and hematuria.     

血管紧张素转换酶抑制剂对单侧动脉粥样硬化性肾动脉狭窄患者肾功能的影响

目的 观察血管紧张素转换酶抑制剂(ACEI)对单侧动脉粥样硬化性肾动脉狭窄(ARAS)患者肾功能的影响&#65377;方法 结合临床表现及肾动脉造影结果诊断单侧ARAS患者共49例, 分为ACEI组20例与对照组29例&#65377;记录基础血压, 检测Scr&#65380; BUN&#65380; Alb, 以MDRD公式计算估计肾小球滤过率(eGFR),行肾动脉彩超检查测量肾脏阻力指数(RI)&#65377;每月测量血压,每6个月复查Scr&#65380;Urea&#65380;Alb并计算eGFR, 观察两组患者随访期间肾功能变化&#65377; 结果 两组患者试验前一般临床资料无显著性差异&#65377;平均随访9.9个月,随访期间两组血压均无明显变化(P > 0.05)&#65377;与试验前比,对照组eGFR无明显变化[(74.5±18.3 )ml·min^-1·(相似文献   

Analysis of association between segmental glomerulosclerosis and renal function decline in IgA nephropathy

Objective To explore the relationship between segmental glomerulosclerosis and the change of renal function in IgA nephropathy (IgAN). Methods It was a single-center retrospective cohort study. The patients with biopsy-proven primary IgAN who were hospitalized in Shenzhen Second People's Hospital from January 1, 2011 to December 31, 2018 were included. Participants with a secondary cause of IgAN, without baseline serum creatinine or renal pathology data for Oxford classification, baseline estimated glomerulofiltration rate (eGFR)＜30 ml?min-1?(1.73 m2)-1, follow-up time＜6 months, or less than three times measurements of followed-up serum creatinine were excluded. The clinical data, laboratory tests and renal pathology data and so on were collected. Patients were divided into absence of segmental glomerulosclerosis (S0) group and segmental glomerulosclerosis (S1) group according to the Oxford classification. The generalized additive mixed model was used to analyze the associations of segmental glomerulosclerosis and longitudinal renal function decline (Renal function was evaluated by using the eGFR). Results There were 280 patients included in this study, with 199 patients in S0 group, and 81 patients in S1 group. Compared with S0 group, patients in S1 group exhibited higher levels of triglyceride, serum uric acid as well as 24-hour urinary protein, and a lower level of eGFR, and had higher proportions of tubular atrophy and interstitial fibrosis (T) (all P＜0.05). After adjusting for age, gender, mean arterial pressure, 24-hour urinary protein, mesangial hypercellularity (M), endocapillary hypercellularity (E), T and crescent (C) in the generalized additive mixed model, the effect value of S1 (the difference of baseline eGFR between S1 group and S0 group) was -14.09 ml?min-1?(1.73 m2)-1. For every additional year, the eGFR of S0 group decreased 1.29 ml?min-1?(1.73 m2)-1 (95% CI 0.47-2.12, P=0.002) in average, and eGFR decline in S1 group had 2.85 ml?min-1?(1.73 m2)-1 more than that in S0 group [95%CI 1.05-4.64, P=0.002]. Conclusion Segmental glomerulosclerosis is independently associated with the longitudinal decrease in renal function in patients with IgAN, which suggests therapies targeted for improving the early damages of segmental glomerulosclerosis may be essential to delay the renal function decline progression.     

Relationship between interventricular septum thickness and renal prognosis in IgA nephropathy patients

Objective To investigate the relationship between interventricular septum thickness (IVST) and renal prognosis in IgA nephropathy patients. Methods A total of 213 patients with IgA nephropathy proven by biopsy from Department of Nephrology of Shenzhen Second People's Hospital were enrolled in this study, and these participants were divided into normal IVST group (＜11 mm) and higher IVST (≥11 mm) group according to IVST. The demographic characteristics, clinical biochemical indexs, CKD stage and pathologic characteristics in these two groups were compared. Binary logistic regression analysis was used to analyze the influencing factors of eGFR＜60 ml?min-1?(1.73 m2)-1, and Kaplan-Meier survival curve was used to analyze the effect of IVST on renal prognosis. Results Compared with IVST normal group, the patients in IVST higher group were more male sex, older, and had higher level of systolic pressure, Hb, Scr, BUN, UA, 24 h urine protein excretion, urinary protein creatinine ratio, triacylglycerol, total cholesterol, LDL, Serum C3, C4, and had more serious mesangial proliferation, tubular atrophy (all P＜0.05). However, the levels of eGFR and HDL were decreased in IVST higher group (both P＜0.05). There were a significant difference in CKD staging distributions and IgA Lee grade between two groups (both P＜0.01). Spearman and Pearson correlation analysis indicated that IVST was negatively correlated with eGFR and positively correlated with proteinuria level in IgA nephropathy patients. Baseline IVST was an independent risk factor of eGFR＜60 ml?min-1?(1.73 m2)-1 in IgA nephropathy patients. Serum C3, UA and hemoglobin were independent influential factors of eGFR decline (all P＜0.05). Kaplan-Meier survival curve indicated that the renal function was worse in patients with thickened interventricular septum. Conclusion The IgA nephropathy patients with thicker interventricular septum has a poor renal prognosis.     

Analysis of incidence and risk factors of renal insufficiency in solitary kidney patients

Objective To investigate the incidence of renal insufficiency in solitary kidney patients and analyze the risk factors. Methods Patients with solitary kidney who were admitted to the Second Hospital of Lanzhou University from January 2012 to January 2019 were retrospectively selected as subjects. According to estimated glomerular filtration rate (eGFR) level, the patients were divided into two groups: eGFR＜60 ml?min-1?(1.73 m2)-1 group and eGFR≥60 ml?min-1?(1.73 m2)-1 group. The data of the general information, laboratory examinations and kidney size were collected, and the differences of the above indicators between the two groups were compared. Logistic regression model was used to analyze the related factors of renal function decline. Results (1) A total of 323 solitary kidney patients with age of (53.8±15.8) years and median duration of 10.0 years were enrolled in the study, including 203 males (62.8%). There were 150 cases (46.4%) with hypertension, 136 cases (42.1%) with proteinuria, and 134 cases (41.5%) with renal insufficiency, even 29 cases(9.0%) had developed into end-stage renal disease. (2) Compared with those in eGFR≥60 ml?min-1?(1.73 m2)-1group, patients in eGFR＜60 ml?min-1?(1.73 m2)-1 group had higher age, mean arterial pressure, serum creatinine, serum uric acid, fasting blood glucose, and higher proportion of hypertension and proteinuria, but had lower proportion of congenital solitary kidney, hemoglobin, plasma albumin and residual kidney diameter. The differences of above indicators were statistically significant ( all P＜0.05). (3) Logistic regression analysis showed that increasing age (every ten years, OR=1.752, 95%CI 1.455-2.109, P＜0.001), anemia (OR=2.327, 95%CI 1.356-3.994, P=0.002), hyperuricemia (OR=5.097, 95%CI 2.873-9.042, P＜0.001) and high urine protein level (every 1+, OR=1.515, 95%CI 1.197-1.919, P=0.001) were independent risk factors for renal dysfunction in solitary kidney patients. Conclusions The incidence of renal insufficiency in solitary kidney patients is 41.5%. Patients with solitary kidney may perform varying degrees of kidney damage, such as hypertension, proteinuria and eGFR decline. Increasing age, anemia, hyperuricemia and high urine protein level are independent risk factors for renal insufficiency in solitary kidney patients.     

Relationship between interventricular septum thickness and renal function in patients with type 2 diabetes mellitus

Objective To investigate the relationship between interventricular septum thickness(IVS) and renal function in patients with diabetes mellitus. Methods Two hundred and sixty-five patients of type 2 diabetes without dialysis were enrolled in a cross-sectional study. According to their IVS, the patients were divided into normal group (IVS≤11 mm) and higher IVS group (IVS＞11 mm). All patients according to evaluated glomerular filtration rate (eGFR) level were divided into eGFR≥60 ml?min-1?(1.73 m2)-1 group and eGFR＜60 ml?min-1?(1.73 m2)-1 group. The demographic characteristic, biochemical examination, eGFR, and proteinuria of different groups were compared. Pearson or spearman correlation was used to analyze the relationship between eGFR, IVS and other parameters. eGFR＜60 ml?min-1?(1.73 m2)-1 and IVS thickening were analyzed by binary logistic regression. Risk factors affect the prognosis of renal function in patients with diabetes mellitus were analyzed by Cox regression analysis. Results Compared with normal group, patients in the higher IVS group had higher systolic pressure (P=0.002), their level of Scr, BUN, 24 h urinary protein were increased (all P＜0.05), while the level of eGFR, albumin (ALB), hemoglobin (Hb) and fasting blood glucose were decreased (all P＜0.05). The prevalence of hypertension was increased (81.16% vs 58.67%, χ2=11.273, P=0.001), and there was also a difference in the proportion of patients in each stage of CKD (χ2=34.593, P＜0.001). Correlation analysis showed that IVS was positively correlated with BMI, systolic BP, Scr, BUN, 24 h urinary albumin, 24 h urinary protein (all P＜0.05), while negative correlation was observed between the thickened degree of IVS and Hb, albumin, eGFR and total calcium (all P＜0.05). It's worth noting that IVS also correlated with history of hypertension and degree of renal injury (all P＜0.01). Logistic regression analysis showed that longer duration of diabetes, higher systolic pressure and BUN were independent risk factors for eGFR＜60 ml?min-1?(1.73 m2)-1 (all P＜0.05), while higher Hb and Alb were independent protective factors for eGFR＜60 ml?min-1?(1.73 m2)-1 (all P＜0.05). Logistic regression analysis also showed that the baseline increased Scr was independent risk factor for interventricular thickening (P＜0.05), while the increase of fasting blood-glucose was independent protective factor for interventricular thickening (P＜0.05). Cox regression analysis showed that interventricular thickening was an independent risk factor in predicting the progression of type 2 diabetes (HR=1.396, 95%CI=1.098-1.774, P=0.006). Conclusion Interventricular septum thickness is closely related to the state of renal function, as well as is an independent risk factor to predict kidney function decline in patients with type 2 diabetes.     

The urate-lowering efficacy of febuxostat and its effect on renal function in hyperuricemic patients with chronic kidney disease stages 3-5

Objective To investigate the urate-lowering efficacy and renal effect of febuxostat in hyperuricemic patients with chronic kidney disease (CKD) stages 3-5. Methods A prospective, randomized, controlled trial of CKD stages 3-5 patients with hyperuricemia was conducted from June 2015 to June 2016. Patients were randomly assigned to either febuxostat group (treatment group) or allopurinol group (control group). Patients in treatment group received febuxostat 40 mg/d after study initiation, and the dosage was changed to 20 mg/d if serum uric acid (sUA)＜360 μmol/L. Patients in control group were administered a dose of 100 mg/d of allopurinol. Serum uric acid, serum creatinine and other clinical parameters were measured at baseline and 1-6 months after treatment. The rate of achieving target sUA level and the change of eGFR in two groups were performed using SPSS 21.0. Results A total of 98 patients met the inclusion criteria and completed the trial. The treatment group and the control group had 51 cases and 47 cases, respectively. There was no significant difference between the two groups in age, sex, body mass index (BMI), blood pressure, serum creatinine, eGFR, sUA and renal diseases (P＞0.05). At month 1-6, there were significant differences between treatment group and control group in the rate of achieving target sUA level (P＜0.01). At month 1 and month 3, no statistical difference was observed in the change of eGFR between the two groups (P=0.624, P=0.319). At month 6, the changes in eGFR were +2.23 ml?min-1?(1.73 m2)-1 and -4.36 ml?min-1?(1.73 m2)-1 in the treatment and control group, respectively, and the difference between the two groups was significant (P=0.037). In patients with CKD stages 3-5, generalized estimating equation showed that after adjusting for confounding variables, the eGFR increased 1.149 ml?min-1?(1.73 m2)-1 (P=0.003) and 24-hour urinary protein decreased 0.019 g/d (P=0.037) when per 60 μmol/L decreased in sUA. Febuxostat 20 mg/d was able to keep target sUA levels in 90.2% patients with CKD stages 3-5 within half a year and no serious adverse effects appeared. Conclusions Febuxostat performs better than allopurinol in lowering urate and delaying progression of renal function in patients with CKD stages 3-5 and HUA. Febuxostat 20 mg/d may be the effective and safe maintenance dose to maintain target sUA level in patients with CKD stages 3-5, but whether it can be used as the best long-term maintenance dose needs to be further studied.