ABSTRACT
Objective To analyze the clinical and pathological data and prognosis of microalbuminuria IgA nephrology patients with decreased serum C3 level, and investigate the significance of decreased serum C3 level in microalbuminuria IgA nephrology patients. Methods Clinical and pathological data of microalbuminuria IgA nephrology patients confirmed by renal biopsy and followed up more than 6 months were reviewed. The patients were divided into decreased serum C3 level group (34 cases, 25.19%) and normal serum C3 level group (101 cases, 74.81%) according to the serum C3 level. Twenty-four hours urine protein quantitative > 1 g, or normal serum creatinine level turning into abnormal level at renal biopsy, or doubling of serum creatinine level was defined as the end point of follow-up. Renal survival was calculated by Kaplan-Meier survival analysis and risk factors of progression were analyzed by Cox regression models. Results Total of 135 microalbuminuria IgA nephrology patients were followed up successfully, with an average follow-up time (53.4 ± 21.9) months. There were 27 cases (79.41%) and 32 cases (31.68%) in the decreased serum C3 level group and the normal serum C3 level group respectively at the endpoint. Kaplan-Meier survival analysis showed that the median survival time was significantly shorter in decreased serum C3 level group compared with that in normal C3 level group: (46.7 ± 9.1) months vs. (68.4 ± 9.9) months, P =0.014. Cox regression analysis showed that abnormal serum creatinine (RR = 1.147, 95% CI: 1.129-1.395, P = 0.008), decreased serum C3 level (RR=1.028, 95%CI:0.672-1.495, P=0.039), urine protein quantitative>1 g/24 h (RR=2.066, 95%CI:1.242-3.838, P=0.006) and renal biopsy pathological indicators Lee classⅢ-Ⅴ(RR=2.820, 95%CI:1.249-5.638, P=0.041), glomerular sclerosis or adhesions (RR=1.232, 95%CI: 1.065-1.520, P = 0.040), renal interstitial atrophy or interstitial fibrosis (RR = 2.604, 95% CI:1.748- 4.104, P = 0.037), endocapillary cell proliferation (RR = 0.872, 95% CI: 0.491- 1.275, P =0.042), crescentic (RR = 1.528, 95% CI: 1.073- 2.385, P = 0.009) affected prognosis of microalbuminuria IgA nephropathy as the independent risk factors. Conclusions The clinical and pathological features in patients of microalbuminuria IgA nephropathy with decreased serum C3 level is more severe, and the prognosis is poor. The patients should be followed up closely and early intervention treatment and early active control of microalbuminuria should be done at the same time.
ABSTRACT
Objective To explore the clinical therapeutic effectiveness,safety and feasibility clinical of leflunomide and cyclophosphamide on lupus nephritis.Methods 34 cases with lupus nephritis were randomly divided into control group and observation group according to the time of admission during January 2013 to July 2014 in Shangdong Jining NO.1 People’s Hospital.17 cases in observation group were given leflunomide;17 cases in control group were given cyclophosphamide,six months was a period of treatment.Two groups were in the process of therapy observed and recorded changes in liver and lidney function indexes,serum albumin 24-hour urinary protein,anti-double stranded DNA antibody titers before and after treatment.At the end of a course, the basic activities of the two groups of lupus index were evaluation.Results The total effective rate in control group was 70.5%, and that was 88.2% in the observation group, there was no difference significant.Compared with the other indexes before and after treatment were statistically significance (P<0.05); the incidence of adverse events in the control group was 42.9%, the incidence of adverse events in the observation group was 14.3%, the difference was statistically significant (P<0.05).Conclusion Leflunomide in treatment of lupus nephritis has significant effect, less side effects and high safety.