Effect of Nephritis Rehabilitation Tablets combined with tacrolimus in treatment of idiopathic membranous nephropathy

BACKGROUND Idiopathic membranous nephropathy(IMN)has a high incidence in the middleaged and elderly population,and poses a great threat to the physical and mental health and quality of life of patients.Nephritis Rehabilitation Tablets have many potential effects,such as clearing residual toxins,tumefying the kidney and spleen,replenishing qi,and nourishing yin,and have played an important role in the treatment of a variety of kidney diseases.AIM To investigate the efficacy and safety of Nephritis Rehabilitation Tablets combined with tacrolimus in the treatment of IMN.METHODS Eighty-four patients with IMN recruited from January 2017 to September 2020 were randomly divided into a study group(n=42)and a control group(n=42).On the basis of routine symptomatic treatment,both groups were treated with tacrolimus,and the study group was additionally treated with Nephritis Rehabilitation Tablets.Both groups were treated for 12 wk.The therapeutic effect,the levels of renal function indexes[serum creatinine(Scr),serum albumin,and 24-h urinary protein],urinary immunoglobulin(IgG4),membrane attack complex(C5b-9),and the incidence of adverse reactions were measured before and after 12 wk of treatment.RESULTS The total effective rate in the study group was significantly higher than that of the control group.Before treatment,there was no significant difference in Scr,serum albumin,or 24 h urinary protein between the two groups.After 12 wk of treatment,the levels of Scr and 24-h urinary protein in both groups were significantly lower and serum albumin was significantly higher than those before treatment(P<0.05),and the levels of Scr and 24-h urinary protein were significantly lower(P=0.003 and 0.000,respectively),and the level of serum albumin was significantly higher(P=0.00)in the study group than in the control group.Before treatment,there was no significant difference in urinary IgG4 and C5b-9 levels between the study group and the control group(P=0.336 and 0.438,respectively).After 12 wk of treatment,the levels of urinary IgG4 and C5b-9 in the two groups were lower than those before treatment,and the levels of urinary IgG4 and C5b-9 in the study group were significantly lower than those in the control group(P=0.000).There was no significant difference in the incidence of adverse reactions between the two groups(P=0.710).CONCLUSION Based on routine intervention,Nephritis Rehabilitation Tablets combined with tacrolimus in the treatment of IMN can effectively improve the renal function of patients and downregulate the expression of urinary IgG4 and C5b-9.In addition,they can improve the overall therapeutic effect while not increasing the risk of adverse reactions.

Efficacy and safety of Nephritis rehabilitation tablet combined with Valsartan for chronic glomerulonephritis:A system review and metaanalysis

Objective:To systematically evaluate the efficacy and safety of Nephritis Rehabilitation Tablet(NRT)combined with valsartan in treatment of chronic glomerulonephritis(CGN).Methods:Computer search databases such as CNKI,CBM,VIP,wanfang,Embase,PubMed and Cochrane library,and find all randomized controlled trials(RCTs)comparing NRT combined with valsartan versus valsartan in treatment of chronic glomerulonephritis.The search time limit is to build the database until October 2020.RCTs were screened according to the inclusion and exclusion criteria.After data extraction and quality assessment,the Cochrane risk of bias tool was used to evaluate the methodological quality of these studies.Meta-analysis was performed by Review Manager 5.2,and GRADE system for evidence quality evaluation.Results:We have identified a total of 24 eligible RCTs with 2082 participants and completed a meta-analysis based on these RCTs.The results of the meta-analysis showed that compared with valsartan,NRT combined with valsartan treatment showed effective curative effect in terms of effective treatment rate(OR=4.72;95%CI,3.67,6.08;P<0.00001),24h urine protein quantification(MD=-0.52;95%CI,-0.59,-0.44;P<0.00001),serum creatinine(Scr)(MD=-10.33;95%CI,-14.00,-6.66;P<0.00001),Systolic blood pressure(SBP)(MD=-11.42;95%CI,-17.67,-5.17;P=0.0003),Diastolic blood pressure(DBP)(MD=-6.28;95%CI,-9.14,-3.42;P<0.0001),Blood urine nitrogen(BUN)(MD=-0.02;95%CI,-0.41,0.37;P=0.93),plasma albumin(ALB)(MD=5.05;95%CI,4.27,5.84;P<0.00001),and adverse reactions(OR=0.93,95%CI,0.54,1.60;P=0.78).No serious adverse events were mentioned in these studies.And based on the results of the systematic review,the GRADE system recommended ranking method was used to evaluate the quality of evidence and the recommendation level.The results showed that the level of evidence was moderate and the recommendation intensity was weak recommendation.Conclusions:NRT combined with valsartan has a significant effect on the treatment of CGN,and the treatment effect is better than valsartan alone.There are no obvious adverse reactions during the treatment process.However,due to the generally low quality of the literature included in these studies,and the variability of the evaluation methods of each study,morelarge samples,multi-center,high-quality samples are still needed RCTs are further verified.