ObjectiveTo systematically review the efficacy and safety of mycophenolate mofetil (MMF) for Henoch-Schonlein purpura nephritis (HSPN). MethodsDatabases such as PubMed, EMbase, CENTRAL, VIP, CNKI, CBM and WanFang Data were electronically searched for comprehensively collecting the randomized controlled trials (RCTs) on the efficacy and safety of MMF for HSPN from inception to December, 2013. Two reviewers independently screened studies according to the inclusion and exclusion criteria, extracted data and evaluated the methodological quality of the included studies. Then meta-analysis was performed using RevMan 5.1 software. ResultsA total of 10 RCTs involving 426 patients (231 in the trial group and 195 in the control group) were included. The trial group was treated with MMF and corticosteroids, and the control group was treated with corticosteroids monotherapy or combined with cyclophosphamide (CTX), leflunomide (LEF), or azathioprine (AZA). The results of meta-analysis showed that, as for efficacy, no significant difference was found between the two groups after six-mouth treatment (OR=1.36, 95%CI 0.67 to 2.73, P=0.85), while after twelve-mouth treatment, MMF was superior to CTX with a significant difference (OR=6.58, 95%CI 2.45 to 17.33, P=0.002). In addition, the efficacy of MMF was still superior to the azathioprine group, but not better than either LEF or prednisone monotherapy. Lower incidence of side effects were found in the MMF group, compared with the CTX group (OR=0.25, 95%CI 0.13 to 0.45, P < 0.000 01) and the prednisone monotherapy group (OR=0.26, 95%CI, 0.09 to 0.79, P=0.02), while there was no significant difference between the MMF group and the LEF group in side effects. ConclusionBased on the current evidence, the efficacy of MMF for HSPN is better than CTX, and its side effects are less than those of CTX and prednisone.
目的 分析朱砂莲中毒导致急性肾功能衰竭临床表现、肾脏病理学及相关文献复习。 方法 2007年3月－9月收治朱砂莲中毒急性肾功能衰竭2例，分析临床表现及肾脏病理损害。 结果 朱砂莲急性中毒易致急性肾功能衰竭，危及生命；其主要损害肾小管间质，表现为急性肾小管重度损伤，无炎性细胞浸润，而肾小球几乎无病变。 结论 朱砂莲为我国常使用中药，主要成分为马兜铃酸，易致马兜铃酸肾病，须提高对该病认识，规范使用中草药，避免药物性所致肾损害。Objective To analyze the clinical and pathological manifestations of kidney in patients with ciliatenerve knotweed root-induced acute renal failure. Methods Two patients who were admitted into our hospital for acute renal failure caused by over-dose ciliatenerve knotweed root from March to September in 2007 were included in this study. We analyzed the clinical and pathological manifestations of their kidneys. Results Over-dose ciliatenerve knotweed root could induce acute renal failure, even threaten life. The pathology of kidney is characterized by severe tubular injury,rather than glomerulus damage, without cell infiltration. Conclusions Ciliatenerve knotweed root is one of the frequently-used traditional Chinese medicines in our country, which can easily result in aristolochinc acid nephropathy. We should recognize the importance of this disease and avoid using nephrotoxic drugs.