Clinical effect of tacrolimus combined with glucocorticoid in the treatment of IgA nephropathy in children / 中国当代儿科杂志

OBJECTIVE@#To study the clinical effect and safety of tacrolimus (TAC) combined with glucocorticoid (GC) versus mycophenolate mofetil (MMF) combined with GC in the treatment of primary IgA nephropathy (IgAN) in children.@*METHODS@#A retrospective analysis was performed for the clinical data of children with primary IgAN confirmed by renal pathology between January 2012 and December 2017. These children were divided into TAC group and MMF group according to the treatment regimen. Their clinical data before treatment and at 1, 3, and 6 months of treatment were collected, and the remission status of IgAN and adverse reactions were compared between the two groups.@*RESULTS@#A total of 43 children who met the inclusion criteria were enrolled, with 15 children in the TAC group and 28 children in the MMF group. At 1 month of treatment, there was no significant difference in the remission status between the two groups (P>0.05). At 3 and 6 months of treatment, the TAC group had a significantly better remission status than the MMF group (P0.05), but fungal infection was observed in one child from the TAC group.@*CONCLUSIONS@#TAC combined with GC can effectively reduce urinary protein in children with primary IgAN, and it has a better short-term clinical effect than MMF combined with GC, with good safety.

Significance of serum cholesterol and fibrinogen in evaluating the risk of glomerulosclerosis in children with nephrotic syndrome / 中国当代儿科杂志

<p><b>OBJECTIVE</b>To investigate the significance of serum cholesterol and fibrinogen (Fib) in evaluating the risk of glomerulosclerosis in children with nephrotic syndrome.</p><p><b>METHODS</b>Sixty-three children with primary nephrotic syndrome were divided into two groups according to their pathological types: minimal change glomerulopathy (MCG) (n=39) and focal segmental glomerulosclerosis (FSGS) groups (n=24). Serum levels of total cholesterol (TC), low-density lipoprotein cholesterol (LDL-C), high-density lipoprotein cholesterol (HDL-C), non-HDL-C and Fib and 24-hour urinary protein excretion were retrospectively analyzed.</p><p><b>RESULTS</b>Serum levels of TC, non-HDL-C, and LDL-C were significantly higher in the FSGS group than in the MCG group (P<0.05), but there were no significant differences in HDL-C, Fib and 24-hour urinary protein excretion between the two groups (P>0.05). According to the results of logistic regression analysis, high levels of LDL-C, non-HDL-C and TC were risk factors for FSGS (P<0.05). In patients whose proteinuria did not disappear after taking enough glucocorticoid for 4 weeks, the level of non-HDL-C was significantly higher in the FSGS group than in the MCG group (P<0.05); there were no significant differences in TC, LDL-C, HDL-C, and Fib between the MCG and FSGS groups (P>0.05).</p><p><b>CONCLUSIONS</b>Serum cholesterol, especially non-LDL-C, is of great significance in evaluating the risk of glomerulosclerosis in children with nephrotic syndrome. There is no sufficient evidence to support serum Fib as a marker for predicting glomerulosclerosis in these children.</p>

Analysis of clinical and pathological characteristics in 167 children with Henoch Sch(o)nlein purpura nephritis / 中华实用儿科临床杂志

Objective To investigate the clinical,renal pathological characteristics of Henoch Sch(O)nlein purpura nephritis (HSPN) in children.Methods One hundred and sixty-seven children hospitalized with HSPN from Jan.2008 to Dec.2011 in the First Affiliated Hospital of Zhengzhou University were divided into 2 groups by 24-hour urinary protein quantity:group A with 24-hour urinary protein quantity ＜ 25 mg/kg,group B with 24-hour urinary protein quantity ≥ 25 mg/kg.Age of onset,gender,injury time of kidney,clinical manifestations,24-hour urinary protein quantity and renal pathological grades of the 2 groups were collected and analyzed.Results In 167 HSPN children,the ratio of male to female was 1.8:1.0.The ages from 5 to 10 years old accounted for 70.7％.Renal injurytime was from a day to 5 months,91.6％ of the HSPN children occurred renal damage within 1 month.HSPN children had clinical signs of gastrointestinal involvement in 56 cases(33.5％),at the same time,the digestive tract and joint involvement in 52 cases(31.1％).Pathological classification of 6 grades:8 cases(4.8％) of grade Ⅰ ;32 cases(19.2％) of grade Ⅱ ;124 cases (74.3 ％) of grade Ⅲ ;3 cases (1.8％) of grade Ⅳ ; no grade Ⅴ or Ⅵ.Pathologic grade of group B was higher than group A,and the difference was significant (P ＜ 0.05).Conclusions The HSPN children,expecially the boys,were more found with digestive tract injury or multiple organ damage.Most HSPN children occurred renal damage within 1 month.The renal biopsy of HSPN children should be positive,especially when the 24-hour urinary protein quantity is ≥25 mg/kg.