Objective We searched for evidence on mycophenolate mofetil(MMF) as a treatment for patients with diffuse proliferative lupus nephritis. Methods We attempted to find the current best evidence by searching The Cochrane Library(Issue 4, 2005), MEDLINE(1990 to June 2007), CMB(1980 to December 2006), CNKI(1979 to October 2007). We critically appraised the available evidence. Results Four systematic reviews and 6 randomized controlled trials of high quality were available. MMF and prednisolone were found to be an effective continuous induction-maintenance treatment for diffuse proliferative lupus nephritis. MMF was associated with less drug toxicity. Conclusion Given the current evidence and our clinical experience, and considering the patient and the values and preferences of his family,MMF was given at 1 g daily in combination with steroids at the beginning. No obvious adverse effects occurred during 3 months of follow-up.
【摘要】 目的 发现提示早期Ⅴ型狼疮性肾炎（lupus nephritis，LN）的指标。 方法 2004年 1月-2009年11月24例经肾活检诊断为Ⅴ型LN患者，与同期50例膜性肾病伴抗核抗体（antinuclear antibody，ANA）阳性患者、50例膜性肾病ANA阴性患者，以及13例膜性肾病ANA阳性且肾组织荧光为“满堂亮”患者的一般资料、肾病表现、肾脏病理以及实验室指标进行比较。 结果 Ⅴ型LN与膜性肾病ANA阴性的患者相比，两组的性别、起病年龄、血红蛋白、补体水平、内皮和系膜增殖的比例等有明显差异。膜性肾病ANA阳性患者的临床和病理表现更接近于ANA阴性的膜性肾病，但其性别比仍以女性居多。而膜性肾病ANA阳性伴“满堂亮”的患者在性别、肾病表现、血红蛋白、补体水平等方面与Ⅴ型LN更为接近。 结论 膜性肾病ANA阳性患者具有异质性，其中肾脏病理表现为“满堂亮”的患者可能系早期Ⅴ型LN。【Abstract】 Objective To find out the clinical and pathological characteristics of early pure class Ⅴ lupus nephritis (LN). Methods A total of 24 patients with pure class Ⅴ LN diagnosed between January 2004 and November 2009 were included, and were compared with 50 antinuclear antibody (ANA)-positive patients with membranous nephropathy (MN) and 50 ANA-negative patients with MN. The clinical and pathological characteristics, laboratory test results were compared between the two groups. Then, 13 patients with "full house" fluorescence in renal biopsy specimens were chosen from the group of ANA-positive membranous nephropathy, whose clinical characteristics and laboratory test were compared with class Ⅴ LN patients. Results There were significant differences in sex ratio, age, positive rate of hepatitis B surface antigen (HBsAg), levels of hemoglobin, white blood cell, platelet,complement, endothelial and mesangial proliferation between class Ⅴ LN and ANA-negative MN group. However, the sex ratio, levels of white blood cell, platelet were similar between class Ⅴ LN and ANA-positive MN group. The renal biopsy specimens in patients with ANA-positive MN with "full house" fluorescence were similar with those in the patients with class Ⅴ LN in sex ratio, renal injury, hemoglobin and complement and the positive rate of hepatitis B surface antigen. Conclusion The demographic information and clinical manifestations in patients with class Ⅴ LN were similar to those in patients with ANA positive MN, especially in the patients wiht ANA-positive MN with "full house" fluorescence in renal biopsy specimens.
目的:探讨黄芪颗粒对紫癜性肾炎的临床疗效,为本病的后续治疗提供更多的药物选择。方法:对我院2003年至2008年收治的51例紫癜性肾炎患儿进行出院后的后续治疗并作随访对照观察。对照组根据病情酌情使用双嘧达莫、泼尼松、中药及对症等。治疗组加服黄芪颗粒,6个月～3岁:每次1/2袋,3～6岁每次2/3袋,6～13岁每次1袋,一天两次,疗程2～3个月。结果:治疗组尿常规异常2例(2/26),对照组8例(8/25),差异有统计学意义(χ2=478,Plt;005);治疗组肾炎复发1例(1/26),对照组5例(5/25),差异有统计学意义(χ2=1543,Plt;001)。结论:黄芪颗粒在紫癜性肾炎后续治疗中有肾脏保护作用,可以明显减少尿常规异常和肾炎复发。
purpose To study the visual electrophysiological changes in patients with chronic glomerulonephritis. Methods The visual evoked potentials(VEP) and electroretinogram(ERG) of 26 subjects with chronic glomerulonephritis in 51 eyes were recorded. Results Ours studies showed the patients with chronic glomerulonephritis had pathologic visual electrophysiologic abnormalities.The N 75 peak latency,b wave peak latency O 1 peak latency and total amplitude of OPs in chronic glomerulonephritis patients without fundus sign showed remarkable difference. Conclusion These changes suggested visual electrophysiological examination may be valuable in early diagnosis of retinal disfunction in patients with chronic glomerulonephritis. (Chin J Ocul Fundus Dis,1998,14:162-164)
Objective By means of evidence-based clinical practice, to find more effective treatment for a hepatitis B related nephritis patient with renal failure. Methods The following databases as Up to Date (May 2011), The Cochrane Library (Issue 5, 2011), PubMed (1978 to 2011) and CNKI (1978 to 2011) were searched to identify systematic reviews and randomized controlled trials (RCTs) of treating hepatitis B related nephritis with glucocorticoid, immunosuppressor or antiviral therapies, and the quality of collected clinical evidence was evaluated by using GRADEpro software. Results The glucocorticoid or combined immunosuppressors was not recommended for existing adverse effects and not acting on the remission of hepatitis B related nephritis and reduction of proteinuria. However, the antiviral therapy used alone was recommended for acting on the remission of hepatitis B related nephritis and the reduction of proteinuria. In view of adverse effects and expensive price of interferon, the nucleoside analogue antiviral agent was suggested. Considering the renal toxicity of adefovir and tenofovir, and possible drug-resistance of lamivudine, the entecavir (0.5 mg qd) was finally selected with patient’s agreement, and the supporting therapies such as lowering blood pressure, and protecting the kidney and liver were adopted continually. After one month treatment, 24-hour urinary protein got reduced, serum albumin got increased, kidney function got stable, and hepatitis B virus DNA quantity got reduced. Conclusion For treating hepatitis B related nephritis with kidney failure, entacavir can reduce 24-hour urinary protein, raise serum albumin, stabilize kidney function and reduce hepatitis B virus DNA in a short term, but its long-term efficacy still requires further studies.
Objective To assess the efficacy and safety of mycophenolate mofetil (MMF) versus cyclophosphamide (CTX) in the induction treatment for lupus nephritis (LN). Methods Such databases as MEDLINE, EMBASE, SCIE, The Cochrane Library, the Cochrane Controlled Trials Register, CBM, and CNKI were searched from their establishment date to August of 2010 to retrieve the randomized controlled trials (RCTs) about MMF versus CTX for LN. The methodology quality of included studies was evaluated. The efficacy indexes i.e. the clinical total remission (TR), complete remission (CR), partial remission (PR), pathological activity index, the chronicity index and complete induction therapy rate (CIR), and the safety indexes i.e. the rate of patient intolerance-to-drug, the incidence of infection, leukopenia and diarrhea, were abstracted. Finally the Meta-analyses were conducted by using Cochrane Collaboration’s RevMan 4.2. Results Eight RCTs involving 773 patients met the inclusive criteria. The results of meta-analyses showed that the total remission rate (OR=1.49, 95%CI 1.10 to 2.02) and complete remission rate (OR=1.67, 95%CI 1.08 to 2.57) were significantly higher in the MMF group than the CTX group. There was no significant difference in the rate of partial remission, the complete induction rate, the rate of patient intolerance-to-drug, the incidence of infection and leukopenia. However, the incidence of diarrhea was higher in the MMF group (OR=2.99, 95%CI 1.87 to 4.78). The results of meta-analyses for type IV LN were the same. Conclusion MMF is superior to CTX in the induction therapy to Lupus Nephritis (type III, IV, V), but the incidence of diarrhea is higher.
Objective To assess the effectiveness and safety of mycophenolate mofetil (MMF) in the treatment of proliferative lupus nephritis. Methods We searched CBM (November 1979 to February 2006), Chinese Cochrane Centre Database (2005), The Cochrane Library (Issue 4, 2005), MEDLINE (November 1966 to February 2006) and EMBASE (1975 to February 2006) for randomize controlled trials. Data were extracted and analyzed using The Cochrane Collaboration’s RevMan 4.2.7. Results Nine randomize controlled trials involving 512 patients met the inclusion criteria. The meta-analysis showed that the total clinical effective rate and complete remission rate were not significantly higher for MMF than for cyclophosphamide, azathioprine, or both. Renal survival rate and relapse rate of MMF were not significantly different from those for cyclophosphamide, azathioprine, or both. Patient survival rate and safety of MMF were significantly improved compared with cyclophosphamide, azathioprine, or both. Conclusion More large-scale multi-center randomized trials are needed to investigate the role of MMF in the treatment of proliferative lupus nephritis.
①住院与门诊患者治疗比较：缺乏比较急性单纯性肾盂肾炎女性住院与门诊患者治疗的随机对照试验（RCT）。②静脉用抗生素治疗单纯性感染女性住院患者（氨苄西林，增效复方磺胺）：缺乏静脉用抗生素与不用抗生素治疗比较的RCT；然而，这种RCT不可能实施。1个在女性单纯性肾盂肾炎住院患者中进行的RCT发现，静脉用氨苄西林＋庆大与静脉用增效复方磺胺＋庆大相比，在临床反应或尿细菌复现上无明显差异。1个在女性单纯性肾盂肾炎住院患者中进行的RCT发现，在临床治疗成功率方面，单剂静脉用妥布霉素＋口服环丙沙星与口服环丙沙星＋安慰剂相比无明显差异。缺乏设计良好的比较新、老静脉用抗生素的试验。③口服抗生素治疗单纯性感染妇女（增效复方磺胺、co-fimoxiclav或fluoroquinolone）：缺乏口服抗生素与不用抗生素比较的RCT；然而，这种RCT不可能实施。1篇有关单纯性肾盂肾炎女性患者的系统评价及随后的1篇RCT发现，在细菌学或临床治愈率方面，口服增效复方磺胺、co-amoxiclav或afluoroquinolone（环丙沙星、诺氟沙星、左氧氟沙星或洛美沙星）之间无差别。