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.
ObjectiveTo systematically review the independent physical risk factors associated with diabetic kidney disease (DKD) in patients with type 2 diabetes mellitus. MethodsWe searched MEDLINE, EMbase, CBM, CNKI and VIP for all studies about the independent physical risk factors associated with diabetic kidney disease (DKD) in patients with type 2 diabetes mellitus up to December 2012. Two reviewers independently screened studies according to the inclusion and exclusion criteria, extracted data, and assessed the methodological quality of included studies. Then meta-analysis was conducted using RevMan 5.2 software. ResultsA total of 11 studies involving 12 957 patients with type 2 diabetes were included. Of these 11 studies, 9 were cross-sectional studies, two were cohort studies, and one was case-control study. The results showed that:the main physical factors associated with DKD were:duration of diabetes (OR=1.11, 95%CI 1.05 to 1.18), waist circumference (OR=1.02, 95%CI 1.00 to 1.04), fasting glucose (OR=1.11, 95%CI 1.07 to 1.16), glycosylated hemoglobin (OR=1.20, 95%CI 1.06 to 1.36), systolic blood pressure (OR=1.03, 95%CI 1.02 to 1.05), diastolic blood pressure (OR=2.41, 95%CI 1.15 to 4.64), triglycerides (OR=1.24, 95%CI 1.02 to 1.51), high-density lipoprotein (OR=0.558, 95%CI 0.369 to 0.844), blood uric acid (OR=1.005, 95%CI 1.002 to 1.009), blood urea nitrogen (OR=1.58, 95%CI 1.37 to 1.82), past history of kidney disease (OR=3.26, 95%CI 1.20 to 8.87) and family history of kidney disease (OR=1.83, 95%CI 1.29 to 2.60). ConclusionCurrent evidence shows that multiple physical factors were associated with the development of type 2 diabetic kidney disease. However, due to the limited quantity and quality of the included studies, more high quality studies are needed to verify the conclusion.