The role of urine IgG in the progression of IgA nephropathy with a high proportion of global glomerulosclerosis

International Urology and Nephrology - IgA nephropathy (IgAN), the most common glomerulonephritis in the world, is an important cause of end-stage renal disease (ESRD). It is necessary to explore...     

Comparison between outcomes of IgA nephropathy with nephrotic-range proteinuria and nephrotic syndrome: do podocytes play a role?

BackgroundNephrotic syndrome (NS) and nephrotic-range proteinuria (NRP) are uncommon in IgA nephropathy (IgAN), and their clinicopathology and prognosis have not been discussed. Podocytes may play an important role in both clinical phenotypes.MethodsWe investigated 119 biopsy-proven IgAN patients with proteinuria over 2 g/d. The patients were divided into three groups according to proteinuria level: the overt proteinuria (OP) group, NS group, and NRP group. In addition, according to the severity of foot process effacement (FPE), the patients were divided into three groups: the segmental FPE (SFPE) group, moderate FPE (MFPE) group, and diffuse FPE (DFPE) group. The outcome was survival from a combined event defined by a doubling of the baseline serum creatinine and a 50% reduction in eGFR or ESRD.ResultsCompared with the NRP group, patients in the NS group had more severe microscopic hematuria, presented with more severe endocapillary hypercellularity and had a higher percentage of DFPE. The Kaplan–Meier curve showed that MFPE patients had a better outcome in the NRP group <50% of tubular atrophy/interstitial fibrosis. In the multivariate model, the NRP group (HR = 17.098, 95% CI = 3.835–76.224) was associated with an increased risk of the combined event, while MFPE (HR = 0.260, 95% CI = 0.078–0.864; p = 0.028) was associated with a reduced risk of the combined event. After the addition of renin-angiotensin system inhibitors (RASi), the incidence of the combined event in the MFPE group (HR = 0.179, 95% CI = 0.047–0.689; p = 0.012) was further reduced.ConclusionsNS presented more active lesions and more severe FPE in IgAN. NRP was an independent risk factor for progression to the renal endpoint, while MFPE indicated a better prognosis in NRP without obvious chronic renal lesions, which may benefit from RASi.     

继发性硬化性胆管炎误诊1例

病例：患者女，57岁，主诉皮肤、巩膜黄染1月余于2006年7月19日入院：患者入院前1个月无明显诱因出现皮肤、巩膜黄染症状，无腹痛、发热、恶心、呕吐和皮肤瘙痒症状：查体腹部无异常体征。既往有多囊肝、多囊肾病史。有子宫切除术史、肝囊肿开窗术史。入院后行磁共振胰胆管造影术（MRCP）示：肝囊肿术后，多发肝囊肿，左右肝管增粗、扩张．考虑为肝门部囊肿压迫所致．     

经内镜及外科手术治疗肝外胆管结石的疗效比较

目的探讨经内镜治疗肝外胆管结石的价值。方法将２００例肝外胆管结石患者分为内镜治疗组（内镜组）及外科手术组（手术组）各１００例,内镜组首先完成经内镜胆胰管造影,诊断确立后即时行十二指肠乳头切开术及胆管取石术;手术组确诊后根据病情选择不同术式,行开腹手术。结果内镜组治愈率为９８％,手术组为９０％（Ｐ＜０．０１）;黄疸消退时间内镜组为（３．０５±０．１２）天,手术组为（７．８３±０．３２）天（Ｐ＜０．０１）;残余结石发生率内镜组为２％,手术组为１０％（Ｐ＜０．０１）;住院时间内镜组为（４．６２±０．１７）天,手术组为（２３．５９±２．７６）天（Ｐ＜０．０１）。结论经内镜治疗肝外胆管结石的疗效明显优于手术疗效,是一种安全可靠的治疗方法。