Dynamic gut microbiome-metabolome in cationic bovine serum albumin induced experimental immune-complex glomerulonephritis and effect of losartan and mycophenolate mofetil on microbiota modulation

Dynamic changes in gut dysbiosis and metabolomic dysregulation are associated with immune-complex glomerulonephritis(ICGN).However,an in-depth study on this topic is currently lacking.Herein,we report an ICGN model to address this gap.ICGN was induced via the intravenous injection of cationized bovine serum albumin(c-BSA)into Sprague-Dawley(SD)rats for two weeks,after which mycophenolate mofetil(MMF)and losartan were administered orally.Two and six weeks after ICGN establishment,fecal samples were collected and 16S ribosomal DNA(rDNA)sequencing and untargeted metabolomic were conducted.Fecal microbiota transplantation(FMT)was conducted to determine whether gut normali-zation caused by MMF and losartan contributed to their renal protective effects.A gradual decline in microbial diversity and richness was accompanied by a loss of renal function.Approximately 18 genera were found to have significantly different relative abundances between the early and later stages,and Marvinbryantia and Allobaculum were markedly upregulated in both stages.Untargeted metabolomics indicated that the tryptophan metabolism was enhanced in ICGN,characterized by the overproduction of indole and kynurenic acid,while the serotonin pathway was reduced.Administration of losartan and MMF ameliorated microbial dysbiosis and reduced the accumulation of indoxyl conjugates in feces.FMT using feces from animals administered MMF and losartan improved gut dysbiosis by decreasing the Firmicutes/Bacteroidetes(F/B)ratio but did not improve renal function.These findings indicate that ICGN induces serous gut dysbiosis,wherein an altered tryptophan metabolism may contribute to its pro-gression.MMF and losartan significantly reversed the gut microbial and metabolomic dysbiosis,which partially contributed to their renoprotective effects.

Echerichia coli Infection—Associated Glomerulonephritis in a Kidney Transplant Patient: A Case Report

Post infectious Glomerulonephritis (PIGN) in renal allograft is a rare entity. Only a few Cases have been described in the literature. The post streptococcal glomerulonephritis is the classic example in native kidney. A wide variety of organism has been associated with PIGN in renal allograft such as Staphylococcus, Cytomegalovirus and Polyomavirus. We describe one case of Infection associated glomerulonephritis due to Echericha Coli, developed 5 years after kidney transplantation, in 47 years old female patient. The Clinical presentation was characterized by a peripheral edema and high blood pressure, and biological tests showed a nephrotic syndrome, an acute kidney injury, a consumption of Complement fractions. The renal biopsy revealed a diffuse endocapillary cell proliferation with preponderant deposits of C3. Total recovery was achieved 4 months after Methyprednisolone pulse and Cyclophasphamid with antimicrobial treatment.

Congophilic fibrils in the glomeruli with polyclonal immunoglobulin gamma staining-another cause for diagnostic overlap:A case report

BACKGROUND Glomerulopathy with fibrillary deposits is not uncommon in routine nephropathology practice,with amyloidosis and fibrillary glomerulonephritis being the two most frequently encountered entities.Renal amyloid heavy and light chain(AHL)is relatively uncommon and its biopsy diagnosis is usually limited to cases that show strong equivalent staining for a single immunoglobulin(Ig)heavy chain and a single light chain,further supported by mass spectrometry(MS)and serum studies for monoclonal protein.But polyclonal light chain staining can pose a challenge.CASE SUMMARY Herein we present a challenging case of renal AHL with polyclonal and polytypic Ig gamma(IgG)staining pattern by immunofluorescence.The patient is a 62-yearold Caucasian male who presented to an outside institution with a serum creatinine of up to 8.1 mg/dL and nephrotic range proteinuria.Despite the finding of a polyclonal and polytypic staining pattern on immunofluorescence,ultrastructural study of the renal biopsy demonstrated the presence of fibrils with a mean diameter of 10 nm.Congo red was positive while DNAJB9 was negative.MS suggested a diagnosis of amyloid AHL type with IgG and lambda,but kappa light chains were also present supporting the immunofluorescence staining results.Serum immunofixation studies demonstrated IgG lambda monoclonal spike.The patient was started on chemotherapy.The chronic renal injury however was quite advanced and he ended up needing dialysis shortly after.CONCLUSION Tissue diagnosis of AHL amyloid can be tricky.Thorough confirmation using other available diagnostic techniques is recommended in such cases.

Short-term renal and patient outcomes of primary immunoglobulinassociated mesangiocapillary glomerulonephritis:Insights from a developing country

BACKGROUND Primary immunoglobulin(Ig)-associated mesangiocapillary glomerulonephritis(Ig-MCGN)is an immune complex glomerulonephritis of unknown etiology.It is a common cause of chronic kidney disease in developing countries.There is limited data available on renal and patient outcomes of this disease from developing countries.AIM To determine the short-term renal and patient outcomes of adults with a tissueconfirmed diagnosis of primary Ig-MCGN at a single center in Pakistan.METHODS A retrospective cohort study of adult patients was conducted on biopsy-proven Ig-MCGN cases diagnosed between 1998 and 2019 at the Sindh Institute of Urology and Transplantation,Karachi,Pakistan.Secondary causes were excluded.The primary endpoint was renal survival without end-stage kidney disease(ESKD)or mortality.The secondary endpoint was the rate of remission during the 2-year follow-up period.Survival curves were made with the use of Kaplan-Meier estimates.RESULTS A total of 163 patients were included in the study and their mean follow-up duration was 29.45 months±21.28 months.Among baseline characteristics,young age,lower estimated glomerular filtration rate,requirement of kidney replacement therapy,presence of crescents,and severity of interstitial fibrosis and tubular atrophy were found to have a significant association with renal outcomes.The renal outcomes were negatively correlated with the presence of hypertension,level of complements,and degree of proteinuria.In all,63(37.4%)patients were treated with steroids and 21(13%)received combination therapy(cyclophosphamide with steroids).At 2 years,124(76.07%)patients were in complete remission or partial remission[56(34.3%)and 68(41.71%),respectively],while 32(19.63%)patients progressed to ESKD and 7(4.29%)patients died.CONCLUSION The outcomes of primary Ig-MCGN are guarded in Pakistan and require further prospective studies to improve our understanding of this relatively common disease so that more personalized treatment approaches can be developed.

Renal Vein Thrombosis Suggestive of Extramembranous Glomerulonephritis Associated with Sjögren’s Syndrome (Case Report)

Introduction: Glomerular damage during Gougerot-Sjgren syndrome is much rarer than interstitial damage, and is essentially extra-membranous and membrano-proliferative glomerulonephritis. Observation: We report the case of a 44-year-old woman with primary Sjgrens syndrome, confirmed by clinical dryness syndrome, positive anti-SSA and anti-SSB antibodies, and a salivary gland biopsy revealing grade 4 lymphocytic sialadenitis according to CHISHOLMs classification. Later, the patient developed nephrotic syndrome, along with hypertension. Renal function remained normal with a creatinine level of 9.3 mg/l, and hematuria was absent. Only antinuclear antibodies tested positive, while anti-PLA2R antibodies were negative. A renal biopsy was performed, which was complicated on the same day by hemodynamic instability with hematuria. Renal CT scan with contrast injection revealed a posterior perirenal hematoma without contrast extravasation. Additionally, bilateral renal vein thrombosis was incidentally discovered, suggesting extramembranous glomerulonephritis. The patients hemodynamic status stabilized after fluid resuscitation with isotonic saline solution (0.9%), without the need for blood transfusion. Renal biopsy confirmed extramembranous glomerulonephritis with interstitial fibrosis and minimal tubular atrophy. The initial etiological assessment was negative. The patient was started on oral corticosteroids, angiotensin-converting enzyme inhibitors, and therapeutic anticoagulation for renal vein thrombosis. The patients condition improved, with the disappearance of the syndrome and spontaneous regression of the hematoma. Discussion: The association of nephrotic syndrome and renal vein thrombosis primarily suggests glomerulopathy, in particular extra-membranous glomerulonephritis. Sjgrens syndrome can be associated with extra-membranous glomerulonephritis without being its direct cause. Like, it is possible that it is a cause of glomerulonephritis, essentially extra membranous and membrano-proliferative. Conclusion: Sjgrens syndrome is generally underestimated cause of glomerulonephritis, which should be considered in cases of extra-membranous glomerulonephritis.

Probing the Variation of Reverberation Lags along with X-Ray Flux in the AGN Mrk 704

Understanding the variation of lags with respect to the X-ray flux is important to explore the geometry of the inner region of the accretion disk in AGNs.We performed frequency-lag,energy–lag and spectral studies for two sets of observations,in order to investigate the variations in lags with respect to X-ray flux in the AGN source Mrk 704 using the XMM-Newton observatory.We divided one of the light curves into two sections which were noticed to exhibit a flux variation.The frequency-lag spectra in different energy domains revealed that reverberation(soft)lags varied along with the flux.For the first time,we show that the blurred reflection model can consistently explain the soft excess observed in the X-ray spectra for this source.The fluxes of soft(i.e.,reflection)and hard components were noted to vary by~18%and~9%respectively,across the sections.The soft lag amplitude was found to be larger at the high flux state than the amplitude at the low flux state.Most importantly,we found that both frequency-lag and energy–lag spectra do not display significant variation between two observational data sets despite a flux variation of 43%.This phenomenon cannot be explained by the reflection model because the soft lag amplitudes must be larger in the high flux state.The probable scenario is that,in the low flux state,the obscuring cloud delays the reflected soft photons which increases the soft lag amplitude.

Approach to Acute Kidney Injury: Diagnosis and Management

Acute kidney injury is a critical but commonly occurring medical condition that presents with a sudden decline in kidney function. This comprehensive review article provides an in-depth examination of the risk elements, etiology, diagnosis, management, and preventive approach of AKI. The causes that contribute to the development of AKI include prerenal, intrinsic renal, and postrenal. The diagnostic approach to AKI includes clinical, laboratory, and imaging studies to evaluate the root cause analysis and to find out the severity of kidney injury. Timely and accurate diagnosis is crucial for initiating appropriate management strategies. The treatment strategies may include fluid and electrolyte management, medication adjustments, nutritional support, and renal replacement therapy. The prospect of recovery diverges as it relies on the individual factors, reasons, and gravity of the condition. This review highlights the importance of raising awareness among healthcare professionals and the public about AKI, early recognition of risk factors, and prompt management. Further research is needed to explore novel therapeutic approaches and refine existing management guidelines for this critical condition.

Infection related membranoproliferative glomerulonephritis secondary to anaplasmosis:A case

BACKGROUND Anaplasmosis is a tick-borne disease with a range of clinical manifestations,from a flu-like illness with fever and myalgias to a severe systemic disease with multisystem organ failure.Although renal involvement is not a common presentation,there have been few cases reporting acute kidney injury from Anaplasmosis.CASE SUMMARY We present a 55-year-old female with anaplasmosis who developed acute kidney injury due to membranoproliferative glomerulonephritis(MPGN).The patient originally presented with cough and shortness of breath.She was admitted to the hospital with a diagnosis of community acquired pneumonia and received antibiotics.During the hospital course she developed severe acute renal failure.Initial serological work up didn’t provide any conclusive diagnosis.Hence,she underwent kidney biopsy which showed MPGN pattern suggesting autoimmune,multiple myeloma or infectious etiology.Extensive work up was undertaken which was negative for autoimmune diseases,vasculitis panel,paraproteinemias but tested positive for IgG anaplasma with high titers indicating Anaplasmosis.CONCLUSION Our case shows a unique presentation of severe acute renal failure from MPGN from tick borne illness.MPGN is usually seen with autoimmune diseases,hepatitis C virus infections,paraproteinemias.Hence,we suggest that tick borne illness should also be considered when evaluating acute renal failure cases in tick borne prevalent regions.

Exploring the Protective Effect of the Ethanolic Extract of Rosa laevigata Michx.Fruit on Rats with Mesangial Proliferative Glomerulonephritis Based on NLRP3 Inflammasome Pathway

Objective:To investigate the effect of the ethanolic extract of Rosa laevigata Michx.fruit on rats with mesangial proliferative glomerulonephritis based on the NLRP3 inflammasome pathway.Methods:Thirty Wistar rats were divided into three groups,a blank control group,a diabetic nephropathy(DN)model group,and an ethanolic extract intervention group,according to the random number table method,with 10 rats in each group.One day before the experiment,basic feeding was initiated for all the rats;the changes in activity and weight of each group of rats were observed and recorded after 7 d,and a rat model of renal function injury was established after 1 d.Results:Compared with the control group,the model group had significantly higher kidney/body ratio,24 h urine protein,serum creatinine(SCr),blood urea nitrogen(BUN),glomerular mesangial cell(GMC)count,and extracellular matrix(ECM)positive area ratio(P<0.05);the same indicators were significantly lower in the intervention group than in the model group(P<0.05).The NLRP3 inflammasome pathway in renal intrinsic cells was activated in the intervention group.The overactivation of NLRP3 inflammasome is known to promote interleukin(IL)-1βrelease,which was inhibited in the intervention group.Conclusion:The ethanolic extract of Rosa laevigata Michx.fruit has a protective effect on renal intrinsic cells and may be related to NLRP3 inflammasome pathway,suggesting that the fruit of Rosa laevigata Michx.has a potential role in protecting renal intrinsic cells from inflammatory damage.NLRP3 inflammasomes are involved in the development of various chronic inflammatory diseases,such as acute and chronic glomerulonephritis and renal fibrosis.

表现为新月体性肾小球肾炎的纤维性肾小球病

34岁女性患者,临床表现为水肿、高血压、大量蛋白尿、镜下血尿、低蛋白血症、血清肌酐升高。肾活检病理光镜示大量新月体形成伴袢坏死,电镜示上皮下、基膜内及系膜区杂乱分布的纤维样结构(直径12~30 nm)沉积,肾小球免疫组化染色DNAJ热休克蛋白家族成员B9(DNAJB9)阳性,诊断为DNAJB9相关纤维性肾小球病、新月体性肾小球肾炎。给予利妥昔单抗、吗替麦考酚酯、糖皮质激素等治疗,获得了较好的临床疗效。

糖皮质激素治疗IgA肾病:来自IgA肾病激素治疗评估的全球研究临床试验的经验

原发性IgA肾病(IgA nephropathy,IgAN)是一种常见的肾小球疾病,是导致肾功能衰竭的重要原因,主要见于青年人和儿童。在过去的几十年里,糖皮质激素疗法一直备受争议。IgA肾病激素治疗评估的全球研究(the therapeutic effects of steroids in IgA nephropathy global,TESTING)始于2012年,是一项国际性、多中心、双盲、随机、安慰剂对照试验,旨在评估在优化支持治疗条件下口服甲泼尼龙治疗进展风险高的IgAN患者的安全性和长期疗效。经过十年的努力,这项研究的成功完成表明,6~9个月的口服甲泼尼龙是保护IgAN高危患者肾功能的有效方案,但也显示出安全问题。TESTING研究发现,与全剂量甲泼尼龙方案相比,减少剂量的甲泼尼龙方案是有益的,且剂量的减少有助于提高甲泼尼龙的使用安全性。总的来说,TESTING研究提供了更多关于IgAN中糖皮质激素治疗剂量和安全性的数据。TESTING研究结果给患有IgAN的患儿提供了重要的启示。随着对IgAN发病机制的深入了解,正在进行的新治疗方案的研究将有助于进一步优化IgAN治疗的获益-风险比。

超声影像组学在肾炎组织学分型中的应用价值

目的探讨基于灰阶超声图像的超声影像组学技术对肾小球肾炎组织学分型的鉴别诊断价值。方法纳入204例患者的肾穿刺活检病理结果和超声资料,根据病理结果分为膜性肾病组133例和系膜增生性肾小球肾炎组71例。由2位医师对超声影像进行勾画并提取影像组学特征,对获得的全部组学特征数据通过最大相关和最小冗余算法(m RMR)初步筛选超声影像组学特征,然后利用经最小绝对收缩和选择算子(LASSO)算法从已筛选特征中选择最优有效特征,并利用随机森林(RF)、支持向量机(SVM)、逻辑回归(LR)、K近邻(KNN)法4种分类器建立预测模型。所有病例按照7︰3比例随机分为训练集和验证集,4种模型分别利用训练集训练后,在验证集中验证,通过比较受试者工作特征(ROC)曲线、Delong检验、GiViTI校准曲线,选择最佳预测模型。采用决策曲线分析评估模型的临床实用性。结果从每幅图像提取837个影像组学特征,经m RMR+LASSO算法共筛选出16个有意义的特征。RF、SVM、LR、KNN 4种预测模型中表现最好的是LR模型,其ROC曲线下面积为0.944,特异度为0.867,敏感度为0.878。GiViTI校准曲线提示模型具有较好的准确度(P>0.05),决策曲线显示预测模型具有较好的临床实用价值。结论超声影像组学对较为常见的肾小球肾炎组织学类型具有较好的鉴别能力,具有良好的应用前景。

慢性肾小球肾炎患者MCP-1和sFlt-1表达与肾功能及预后的相关性研究

目的:分析慢性肾小球肾炎患者血清单核细胞趋化蛋白-1(MCP-1)和可溶性血管内皮细胞生长因子受体1(sFlt-1)水平变化及其与肾功能和预后的关系。方法:纳入2018-01—2020-03本院收治的慢性肾小球肾炎患者122例(研究组),选取同时期本院体检健康者128例(对照组)。研究组依据肾功能损害情况分为A组(肾功能正常16例)、B组(轻中度肾功能损害88例)、C组(重度肾功能损害18例);根据随访结局,将患者分为肾功能衰竭组(22例)和病情缓解组(100例)。采用酶联免疫吸附法(ELISA)检测受试者MCP-1、sFlt-1水平。采用全自动生化分析仪检测所有受试者血尿素氮(BUN)、血肌酐(Scr)水平,采用慢性肾脏疾病流行病学合作研究公式(CKD-EPI)估算肾小球滤过率(eGFR)。Pearson法分析MCP-1、sFlt-1与BUN、Scr、eGFR的相关性。采用受试者工作特征(ROC)曲线评价血清MCP-1、sFlt-1水平预测慢性肾小球肾炎患者预后的价值。结果:与对照组相比,研究组MCP-1、sFlt-1、BUN、Scr水平较高(P<0.05),eGFR较低(P<0.05)。C组BUN、Scr、MCP-1、sFlt-1水平明显高于A组、B组(P<0.05),B组BUN、Scr、MCP-1、sFlt-1水平明显高于A组(P<0.05)。Pearson相关性分析显示,MCP-1与BUN、Scr均呈正相关(P<0.05),与eGFR呈负相关(P<0.05),sFlt-1与BUN、Scr均呈正相关(P<0.05),与eGFR呈负相关(P<0.05)。与病情缓解组相比,肾功能衰竭组患者清中MCP-1、sFlt-1水平较高(P<0.05)。ROC分析显示,血清MCP-1、sFlt-1水平预测慢性肾小球肾炎患者预后的AUC分别为0.967、0.965,MCP-1联合sFlt-1预测慢性肾小球肾炎患者预后的AUC为0.984,灵敏度100.00%,特异度94.00%。结论:慢性肾小球肾炎患者血清MCP-1、sFlt-1水平明显上升,可作为患者预后评估的潜在生物学指标。

激素治疗慢性肾脏病进展高风险IgA肾病患者的预后分析——一项回顾性研究

背景IgA肾病(IgAN)是世界范围内常见的原发性肾小球肾炎之一,目前糖皮质激素是否能改善慢性肾脏病(CKD)进展高风险IgAN患者肾脏预后尚无明确结论。目的本研究旨在探讨激素治疗对CKD进展高风险IgAN患者的治疗反应及肾脏预后的影响。方法回顾性纳入2017年1月—2021年10月于郑州大学第一附属医院就诊的CKD进展高风险IgAN患者。根据是否进行激素治疗将患者分为激素治疗组和支持治疗组,采用倾向匹配法按照性别、年龄、24 h尿蛋白定量、估算肾小球滤过率(eGFR)对患者进行1∶1匹配筛选病例,收集患者的临床及病理资料,记录患者治疗1年内疾病缓解情况及不良反应发生情况。以开始支持治疗的日期作为随访起点,随访至2022-10-31,主要终点事件定义为:进展为终末期肾脏病(ESRD)或接受透析治疗。复合终点事件定义为:eGFR较基线持续下降超过30%或进入ESRD或接受透析或患者死亡;运用Kaplan-Meier法绘制生存曲线,并采用Log-rank检验比较两组患者主要/复合终点事件累积发生率的差异。运用Cox比例风险回归分析探究影响CKD进展高风险IgAN患者预后的可能因素。结果共有236例原发性IgAN患者符合纳入标准,经过1∶1匹配,激素治疗组97例与支持治疗组97患者匹配成功,两组基线数据匹配均衡。激素治疗组患者完全缓解率、部分缓解率均高于支持治疗组(χ^(2)=6.171,P=0.013;χ^(2)=3.973,P=0.046)。中位随访时间为18.00(9.75,28.00)个月。Kaplan-Meier生存分析结果显示,激素治疗组的主要终点事件累积发生率低于支持治疗组(χ^(2)=4.495,P=0.034);激素治疗组的复合终点事件累积发生率低于支持治疗组(χ^(2)=4.419,P=0.036)。符合纳入标准的236例患者中有177例中等量蛋白尿患者,采用倾向匹配法按照性别、年龄、24 h尿蛋白定量、eGFR对激素治疗和支持治疗的177例患者进行1∶1匹配后,激素治疗中等量蛋白尿者和支持治疗中等量蛋白尿者各有76例患者匹配成功。Kaplan-Meier生存曲线结果显示,激素治疗中等量蛋白尿者的主要终点事件累积发生率低于支持治疗中等量蛋白尿者(χ^(2)=4.127,P=0.042);激素治疗中等量蛋白尿者的复合终点事件累积发生率低于支持治疗中等量蛋白尿者(χ^(2)=4.934,P=0.026)。多因素Cox比例风险回归分析结果显示血红蛋白(HR=0.982)、血肌酐(HR=1.019)、eGFR(HR=1.020)、24 h尿蛋白定量(HR=1.205)是影响CKD进展高风险IgAN患者发生主要终点事件的影响因素(P<0.05)。激素治疗组感染发生率高于支持治疗组(P<0.05)。结论在CKD进展高风险IgAN肾病患者中,与单纯支持治疗相比,激素治疗可以显著提升肾脏缓解率,降低肾功能下降、肾衰竭风;但仍需警惕其不良反应的发生。

少毛症-淋巴水肿-毛细血管扩张-肾缺陷综合征

少毛症-淋巴水肿-毛细血管扩张症(hypotrichosis-lymphedema-telangiectasia syndrome,HLTS)是一种由SOX18基因变异引起的罕见的临床综合征性淋巴水肿疾病,为常染色体显性或隐性遗传性疾病,好发于新生儿期及婴儿期,其特征是早发性少毛症、淋巴水肿及毛细血管扩张,而少毛症-淋巴水肿-毛细血管扩张-肾缺陷综合征(HLT-renal defect syndrome,HLTRS)是伴有肾损害的HLTS,除有HLTS的临床特征外,还存在补体正常的膜增生性肾小球肾炎。虽HLTRS的患病率不足百万分之一,我国尚未有该病的相关报道,但考虑我国人口基数大,可能存在对该病认识不足情况,现对HLTRS的发病机制、诊断及治疗进行总结,以期提高对该病的认识。

参芪颗粒对急性肾小球肾炎水肿模型大鼠的作用研究

目的研究参芪颗粒对急性肾小球肾炎水肿模型大鼠的影响。方法选取48只SD大鼠,除空白对照组外,其余均制备为急性肾小球肾炎水肿模型。造模成功后,将大鼠分为模型对照组、参芪颗粒高剂量组、参芪颗粒中剂量组、参芪颗粒低剂量组、阳性对照组,每组8只,连续给药4周。测定大鼠的24h尿量、24h尿蛋白含量及血清肌酐(Scr)、血清尿素氮(BUN)、血清白蛋白(ALB)含量。结果与模型对照组比较,参芪颗粒高剂量可以显著增加大鼠的24h尿量、降低大鼠24h尿蛋白(P<0.05);参芪颗粒高剂量可以极显著地降低大鼠的血清Scr、BUN含量(P<0.01)并显著升高血清ALB含量(P<0.05),参芪颗粒中剂量可以非常显著地降低血清Scr、BUN含量(P<0.01)。结论参芪颗粒可以明显改善急性肾小球肾炎水肿模型大鼠的肾功能状态,效果显著。

慢性肾小球肾炎中西医结合治疗研究进展

慢性肾小球肾炎是一种常见的原发性肾小球疾病。该疾病通常导致肾功能逐步退化,并可能引发蛋白尿、血尿、高血压和水肿等一系列症状,严重时甚至可能进展为慢性肾衰竭和重度贫血,严重影响患者的健康和日常生活。传统治疗方案主要依赖于降压药物、激素和细胞毒性药物,以缓解肾功能的进一步恶化。近年来,随着中医学的不断发展,中医辨证施治理念开始应用于慢性肾小球肾炎的治疗实践中,能够有效缓解血尿、水肿和高血压等症状。中西医联合治疗较单纯西药治疗慢性肾小球肾炎在疗效上具有更大的优势,且能够减少毒副作用。为进一步提升临床治疗效果,现代医学与中医学的结合治疗模式被广泛采用,这种跨学科的合作能够有效提升慢性肾小球肾炎的治疗效果,不仅能减轻患者的症状,改善肾功能,还能有效延缓慢性肾衰竭的进程,从而提高患者的生活质量。本文对慢性肾小球肾炎中西医结合治疗的研究进展进行综述,以期为慢性肾小球肾炎的临床治疗提供参考。

基于名中医经验的中医辨证组方治疗老年慢性肾炎(CKD1~3a期)患者随机对照研究

目的:观察基于名中医经验的中医辨证组方对老年慢性肾炎(CKD1-3a期)患者的有效性和安全性。方法:将84例老年慢性肾炎患者随机分成治疗组(42例)和对照组(42例)。治疗组采用西医基础联合中医辨证组方治疗;对照组仅接受西医基础治疗,疗程均为24周。观察两组治疗前后24 h尿蛋白定量(24 h UPQ)、肾小球滤过率(eGFR)等临床指标变化,以及疗效和安全性。结果:与本组基线比较,两组治疗后12、18、24周24 h UPQ均显著下降(P<0.01),且24周时治疗组优于对照组(P<0.01)。治疗组总有效率为67.57%,对照组总有效率41.67%,治疗组显著高于对照组(P<0.05)。将慢性肾脏病(CKD)3a期患者进行亚组分析提示,24周后治疗组eGFR较本组基线及同期对照组显著升高(P<0.01,P<0.05),而对照组治疗前后无显著变化。治疗组不良反应发生4例,对照组2例,两组无严重不良反应出现。结论:基于名中医经验的中医辨证组方治疗老年慢性肾炎(CKD1-3a期),可减少尿蛋白,提高临床疗效,对其中的CKD3a期患者可能具有改善eGFR作用,且安全性较好。

Murtagh安全诊断策略联合思维导图构建临床思维在全科教学门诊中的应用

全科教学门诊是培养住院医师规范化培训(简称住培)全科医生临床思维、提升全科诊疗能力的重要培训方法。本文用1例以乏力为主要表现的患者为教学案例,介绍全科教学门诊中采用澳大利亚著名全科医学专家John Murtagh提出的Murtagh安全诊断策略启发住培全科医生对乏力进行诊断与鉴别诊断:(1)引起乏力的常见疾病有哪些?(2)哪些重要疾病是不能忽视的?(3)乏力有什么容易被遗漏的疾病?(4)是否存在潜在的容易被掩盖的疾病?(5)患者是否有话没有说?结合病史、体格检查和实验室检查结果初步诊断为抗中性粒细胞胞浆抗体相关性血管炎引起急进性肾小球肾炎可能性大,及时转诊,肾病理检查确诊乏力的病因为抗中性粒细胞胞浆抗体相关性肾小球肾炎,取得满意疗效。带教老师基于Murtagh安全诊断策略帮助住培全科医生构建乏力鉴别、分析的系统知识框架,从而提升住培全科医生的临床逻辑思维能力和解决临床实际问题的能力;以思维导图为辅助工具,将Murtagh安全诊断策略诊断与鉴别诊断思路可视化、形象化,优化教学效果。

黄蛭益肾胶囊联合阿魏酸哌嗪片治疗慢性肾小球肾炎临床研究

目的:观察黄蛭益肾胶囊联合阿魏酸哌嗪片治疗慢性肾小球肾炎的临床疗效。方法:按随机数字表法将96例慢性肾小球肾炎患者分为2组各48例。西药组给予阿魏酸哌嗪片治疗,联合组给予黄蛭益肾胶囊联合阿魏酸哌嗪片治疗。比较2组治疗前后中医证候积分、T淋巴细胞亚群及肾功能指标,比较2组临床疗效与不良反应。结果:联合组总有效率97.92%,高于西药组85.42%(P<0.05)。治疗后,2组中医证候积分均降低(P<0.05),且联合组低于西药组(P<0.05)。治疗后,2组CD3^(+)、CD4^(+)、CD4^(+)/CD8^(+)均升高(P<0.05),CD8^(+)降低(P<0.05),且联合组CD3^(+)、CD4^(+)、CD4^(+)/CD8^(+)高于西药组(P<0.05),CD8^(+)低于西药组(P<0.05)。治疗后,2组血清尿素氮(BUN)、血肌酐(SCr)、肾小球滤过率(GFR)均降低(P<0.05),且联合组低于西药组(P<0.05)。联合组不良反应发生率4.17%,低于西药组18.75%(P<0.05)。结论:黄蛭益肾胶囊联合阿魏酸哌嗪片治疗慢性肾小球肾炎能提高临床疗效,改善肾功能与免疫功能,安全性高。