【摘要】 目的 發現提示早期Ⅴ型狼瘡性腎炎（lupus nephritis，LN）的指標。 方法 2004年 1月-2009年11月24例經腎活檢診斷為Ⅴ型LN患者，與同期50例膜性腎病伴抗核抗體（antinuclear antibody，ANA）陽性患者、50例膜性腎病ANA陰性患者，以及13例膜性腎病ANA陽性且腎組織熒光為“滿堂亮”患者的一般資料、腎病表現、腎臟病理以及實驗室指標進行比較。 結果 Ⅴ型LN與膜性腎病ANA陰性的患者相比，兩組的性別、起病年齡、血紅蛋白、補體水平、內皮和系膜增殖的比例等有明顯差異。膜性腎病ANA陽性患者的臨床和病理表現更接近于ANA陰性的膜性腎病，但其性別比仍以女性居多。而膜性腎病ANA陽性伴“滿堂亮”的患者在性別、腎病表現、血紅蛋白、補體水平等方面與Ⅴ型LN更為接近。 結論 膜性腎病ANA陽性患者具有異質性，其中腎臟病理表現為“滿堂亮”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.
Objective To systematically review the effect of allopurinol on renal function in patients with chronic kidney disease (CKD). Methods The PubMed, EMbase, Cochrane Library, WanFang Data, CNKI, and VIP databases were searched for randomized controlled trials (RCTs) of the effect of allopurinol on renal function in patients with CKD. Databases for articles published between establishment of the database and April 28, 2021 were searched. Two evaluators independently screened the literature, extracted data and evaluated the risk of bias of the included studies. RevMan 5.4 was then used for meta-analysis. Results A total of 20 RCTs comprising 2 338 patients were included. The results of meta-analysis showed that compared with the control group, allopurinol substantially reduced the serum uric acid (MD=?2.48, 95%CI ?3.08 to ?1.89, P<0.01). In addition, the effect of allopurinol on slowing the decline in eGFR was influenced by the serum uric acid concentration. Participants taking allopurinol whose serum uric acid concentrations were maintained at >6 mg/dL showed a slower decline in eGFR (MD=5.03, 95%CI 1.76 to 8.31, P<0.01). However, there was no difference in the decline in eGFR between the two groups when the serum uric acid concentration of the participants was <6 mg/dL. Among participants with CKD and moderate renal dysfunction at baseline, those taking allopurinol showed a slower decline in eGFR than controls (MD=3.33, 95%CI 1.14 to 5.52, P<0.01). A further subgroup analysis showed that those who maintained their serum uric acid concentration above 6 mg/dL experienced a slower decline in eGFR (MD=5.46, 95%CI 2.06 to 8.86, P<0.01). However, when the serum uric acid concentration was <6 mg/dL, there was no difference between the allopurinol and control groups. Moreover, the serum creatinine concentration of the allopurinol group was lower than that of the control group after the intervention (MD=?0.39, 95%CI ?0.58 to ?0.19), P<0.01). However, there was no significant difference in the incidence of progression to end-stage kidney disease between the two groups (RR=0.96, 95%CI 0.65 to 1.42, P=0.85). Conclusion Allopurinol can substantially reduce serum uric acid and may protect the kidneys of patients with CKD when the serum uric acid concentration is maintained above 6 mg/dL.
目的 回顧性觀察糖皮質激素聯合小劑量嗎替麥考酚酯（MMF）對IgA腎病的臨床療效及安全性。 方法 2010年9月－2012年9月在我科門診就診的28例IgA腎病患者接受了小劑量MMF聯合激素治療。醋酸潑尼松起始劑量為0.6 mg/（kg·d），MMF起始劑量為0.5～1.0 g/d，2～4周內調節藥物劑量使血藥濃度（MPA-AUC）維持在30～60 mg·h/L。治療前及治療后每月隨訪觀察血清肌酐、血清白蛋白、尿蛋白定性、24 h尿蛋白定量及藥物不良反應等指標。誘導期初定為6個月，若6個月未完全緩解（CR）則延長至9個月，總療程至少12個月，主要評價指標為誘導治療期的完全緩解率。 結果 全部患者均完成了12個月的隨訪觀察，全組28例中CR 8例（28.6%），部分緩解（PR）14例（50.0%），未緩解（NR）6例（21.4%），總有效率78.6%。隨訪過程中，3例患者出現呼吸道感染，其中2例住院治療；2例患者出現尿路感染，1例患者出現腹瀉。 結論 小劑量MMF治療IgA腎病安全、有效且能在一定程度上節省患者費用，可作為其他免疫抑制方案治療無效或復發時的一種治療選擇。
目的 分析朱砂蓮中毒導致急性腎功能衰竭臨床表現、腎臟病理學及相關文獻復習。 方法 2007年3月－9月收治朱砂蓮中毒急性腎功能衰竭2例，分析臨床表現及腎臟病理損害。 結果 朱砂蓮急性中毒易致急性腎功能衰竭，危及生命；其主要損害腎小管間質，表現為急性腎小管重度損傷，無炎性細胞浸潤，而腎小球幾乎無病變。 結論 朱砂蓮為我國常使用中藥，主要成分為馬兜鈴酸，易致馬兜鈴酸腎病，須提高對該病認識，規范使用中草藥，避免藥物性所致腎損害。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.