Calcineurin inhibitors (CNI) are potent immunosuppressive agents in prophylaxis against graft rejection and autoimmune diseases including primary glomerulopathies. Previous research showed reversible;acute afferent ar...Calcineurin inhibitors (CNI) are potent immunosuppressive agents in prophylaxis against graft rejection and autoimmune diseases including primary glomerulopathies. Previous research showed reversible;acute afferent arteriolar vasculopathy and irreversible chronic interstitial fibrosis associated with CNI nephrotoxicity. In this case report we describe a patient, with minimal change disease, that had developed chronic and progressive renal disease while receiving therapeutic dose of Tacrolimus. His serum creatinine had reached 537 umol/L and his nephrotic state worsened. Kidney biopsy showed chronic interstitial nephritis. Tacrolimus was discontinued and he was treated with 1 mg/kg prednisone in addition to Mycophenolate mofetil (MMF) 1 g twice daily. By the 2<sup>nd</sup> month;serum creatinine returned to normal and by the 3<sup>rd</sup> month serum albumin too. After 1 month of therapy;the dose of Prednisone was tapered down gradually till 5 mg daily by the end of 3<sup>rd</sup> month. Moreover, the dose of MMF was reduced to 500 mg X2 by the end of 3<sup>rd</sup> month. After 2 years of follow up;he remained stable and without relapse of NS or renal failure. In conclusion, reversible renal disease, due to chronic interstitial nephritis can be induced by CNI which is amenable to treatment with Prednisone and MMF.展开更多
目的探讨肾炎康复片联合舒洛地特治疗肾病综合征合并类固醇糖尿病的疗效及对β2-MG、CRP、HCY水平影响。方法选取医院治疗的84例肾病综合征合并类固醇糖尿病炎患者,随机分为两组各42例。对照组患者给予舒洛地特,治疗组在对照组基础上口...目的探讨肾炎康复片联合舒洛地特治疗肾病综合征合并类固醇糖尿病的疗效及对β2-MG、CRP、HCY水平影响。方法选取医院治疗的84例肾病综合征合并类固醇糖尿病炎患者,随机分为两组各42例。对照组患者给予舒洛地特,治疗组在对照组基础上口服肾炎康复片,两组患者均持续治疗6个月。对比两组患者的临床疗效、中医症候积分、Scr、ALB、BUN、24 h UPE水平、2 h PG、FBG、HbA1c和FINS水平、β2-MG、CRP、HCY水平、补体C3、IgG和CD^(+)_(4)/CD^(+)_(8)水平。结果治疗后,治疗组总有效率较高(P<0.05);两组患者治疗前中医证候积分差异无统计学意义(P>0.05);两组患者治疗后腰脊酸痛、疲倦乏力、面浮肢肿、肢体困重等证候评分显著降低(P<0.05);并且治疗组腰脊酸痛、疲倦乏力、面浮肢肿、肢体困重评分明显低于对照组(P<0.05);两组患者治疗前Scr、ALB、BUN、24 h UPE水平差异无统计学意义(P>0.05);两组患者治疗后Scr、BUN、24 h UPE显著降低,ALB水平明显升高(P<0.05);并且治疗组改善较多(P<0.05);两组患者治疗前2 h PG、FBG、HbA1c和FINS水平差异无统计学意义(P>0.05);两组患者治疗后2 h PG、FBG、HbA1c和FINS水平显著降低(P<0.05);并且治疗组2 h PG、FBG、HbA1c明显低于对照组(P<0.05),治疗组患者FINS水平低于对照组,但但差异无统计学意义(P>0.05);两组患者治疗前β2-MG、CRP、HCY水平差异无统计学意义(P>0.05);治疗后两组患者β2-MG、CRP、HCY水平显著降低(P<0.05);并且治疗组降低较多(P<0.05);两组患者治疗前补体C3、IgG和CD^(+)_(4)/CD^(+)_(8)水平差异无统计学意义(P>0.05);对照组患者治疗前后补体C3、IgG和CD^(+)_(4)/CD^(+)_(8)水平变化无统计学意义(P>0.05);治疗组患者治疗后补体C3、IgG和CD^(+)_(4)/CD^(+)_(8)水平高于对照组,但差异无统计学意义(P>0.05)。结论采用肾炎康复片联合舒洛地特治疗肾病综合征合并类固醇糖尿病具有较好的治疗效果,能够改善血清β2-MG、CRP、HCY水平,安全性较高,值得在临床上推广应用。展开更多
文摘Calcineurin inhibitors (CNI) are potent immunosuppressive agents in prophylaxis against graft rejection and autoimmune diseases including primary glomerulopathies. Previous research showed reversible;acute afferent arteriolar vasculopathy and irreversible chronic interstitial fibrosis associated with CNI nephrotoxicity. In this case report we describe a patient, with minimal change disease, that had developed chronic and progressive renal disease while receiving therapeutic dose of Tacrolimus. His serum creatinine had reached 537 umol/L and his nephrotic state worsened. Kidney biopsy showed chronic interstitial nephritis. Tacrolimus was discontinued and he was treated with 1 mg/kg prednisone in addition to Mycophenolate mofetil (MMF) 1 g twice daily. By the 2<sup>nd</sup> month;serum creatinine returned to normal and by the 3<sup>rd</sup> month serum albumin too. After 1 month of therapy;the dose of Prednisone was tapered down gradually till 5 mg daily by the end of 3<sup>rd</sup> month. Moreover, the dose of MMF was reduced to 500 mg X2 by the end of 3<sup>rd</sup> month. After 2 years of follow up;he remained stable and without relapse of NS or renal failure. In conclusion, reversible renal disease, due to chronic interstitial nephritis can be induced by CNI which is amenable to treatment with Prednisone and MMF.
文摘目的探讨肾炎康复片联合舒洛地特治疗肾病综合征合并类固醇糖尿病的疗效及对β2-MG、CRP、HCY水平影响。方法选取医院治疗的84例肾病综合征合并类固醇糖尿病炎患者,随机分为两组各42例。对照组患者给予舒洛地特,治疗组在对照组基础上口服肾炎康复片,两组患者均持续治疗6个月。对比两组患者的临床疗效、中医症候积分、Scr、ALB、BUN、24 h UPE水平、2 h PG、FBG、HbA1c和FINS水平、β2-MG、CRP、HCY水平、补体C3、IgG和CD^(+)_(4)/CD^(+)_(8)水平。结果治疗后,治疗组总有效率较高(P<0.05);两组患者治疗前中医证候积分差异无统计学意义(P>0.05);两组患者治疗后腰脊酸痛、疲倦乏力、面浮肢肿、肢体困重等证候评分显著降低(P<0.05);并且治疗组腰脊酸痛、疲倦乏力、面浮肢肿、肢体困重评分明显低于对照组(P<0.05);两组患者治疗前Scr、ALB、BUN、24 h UPE水平差异无统计学意义(P>0.05);两组患者治疗后Scr、BUN、24 h UPE显著降低,ALB水平明显升高(P<0.05);并且治疗组改善较多(P<0.05);两组患者治疗前2 h PG、FBG、HbA1c和FINS水平差异无统计学意义(P>0.05);两组患者治疗后2 h PG、FBG、HbA1c和FINS水平显著降低(P<0.05);并且治疗组2 h PG、FBG、HbA1c明显低于对照组(P<0.05),治疗组患者FINS水平低于对照组,但但差异无统计学意义(P>0.05);两组患者治疗前β2-MG、CRP、HCY水平差异无统计学意义(P>0.05);治疗后两组患者β2-MG、CRP、HCY水平显著降低(P<0.05);并且治疗组降低较多(P<0.05);两组患者治疗前补体C3、IgG和CD^(+)_(4)/CD^(+)_(8)水平差异无统计学意义(P>0.05);对照组患者治疗前后补体C3、IgG和CD^(+)_(4)/CD^(+)_(8)水平变化无统计学意义(P>0.05);治疗组患者治疗后补体C3、IgG和CD^(+)_(4)/CD^(+)_(8)水平高于对照组,但差异无统计学意义(P>0.05)。结论采用肾炎康复片联合舒洛地特治疗肾病综合征合并类固醇糖尿病具有较好的治疗效果,能够改善血清β2-MG、CRP、HCY水平,安全性较高,值得在临床上推广应用。
