Clinical observation on treatment of chronic allograft nephropathy with colquhounia root tablet combined with immunosuppressive protocol / 中国中西医结合杂志

<p><b>OBJECTIVE</b>To observe the effects of Colquhounia root tablet (CRT) combined with immunosuppressive protocal in treating patients with chronic allograft nephropathy (CAN).</p><p><b>METHODS</b>Thirty-three patients of CAN, with urinary protein > or = 1.0 g/24 h and serum creatinine (SCr) > or =150 (micromol/L), were assigned to two groups, the 15 in the treated group treated with CRT combining modified immunosuppressive protocol (IIP) therapy and the 18 in the control group treated with IIP alone, all for 6 months. The clinical efficiency, 24 h urinary protein and clearance of creatinine (CCr) were observed.</p><p><b>RESULTS</b>The effective rate in the treated group [60% (9/15 cases)] was significantly higher than that in the control group [22.0% (4/18 cases), P < 0.05], and the lowering of 24 h urinary protein in the former was more significant than in the latter at the end of the 3rd and the 6th month of treatment (P < 0.05). At the end of 12-month follow-up, SCr and CCr level were stable in the treated group, while in the control group, SCr level increased and CCr level decreased significantly (P < 0.05), comparisons of the two indexes between the two groups at the end of the therapeutic course and follow-up study all showed significant differences (P < 0.05). Serum creatinine doubling to baseline were seen in 2 patients of the treated group and 7 of the control group. One patient in the treated group and 4 in the control group entered the end stage of renal disease.</p><p><b>CONCLUSION</b>Therapy with CRT combined IIP seems to be more effective in reducing urinary protein excretion in patients with CAN than that with IIP alone, and a more favorable renal function preserving effect of the former is shown by a short-term follow-up.</p>

Clinical study on treatment of early diabetic nephropathy by tangshenling combined with telmisartan / 中国中西医结合杂志

<p><b>OBJECTIVE</b>To study the effects and the possible mechanism of Tangshenling (TSL) combined with telmisartan on early diabetic nephropathy (DN). Methods Eighty-one patients with early DN were randomly assigned into the control group (n=40) treated by telmisartan alone and the treated group (n=41) treated by TSL combined with telmisartan, and the conventional western therapy was given to all patients in both groups. Changes before and after treatment in symptoms and levels of urine albumin excretion rate (UAER), urine transforming growth factor beta1 (TGF-beta1), retinol binding protein (RBP) and beta2-microglobulin (beta2-MG), fasting blood glucose (FBG), serum creatinine (SCr), blood lipids, plasma atrial natriuretic peptide (ANP), serum collagen type IV (Col-IV) and TGF-beta1 were observed.</p><p><b>RESULTS</b>Before treatment, no significant difference was shown in all these indexes between the treated group and the control group. After 8 weeks of treatment, the effective rates in symptoms improvement were higher in the treated group than those in the control group (P < 0.05 or P < 0.01); UAER, urine RBP, beta2-MG and TGF-beta1, serum TC, TG, Col-IV and TGF-beta1, and blood pressure were significantly lowered in both groups after treatment (P < 0.05 or P < 0.01); and the treated group showed a better effect than the control group in improving all the above-mentioned indexes except the blood pressure (P < 0.05); but there was no significant difference in the changes of FBG, SCr and blood pressure between the 2 groups (P > 0.05); after treatment, plasma ANP significantly lowered in the treated group (P < 0.01), while there was no significant change of that in the control group (P > 0.05). Conclusion Combination of TSL and telmisartan has a better effect than telmisartan on DN in early stage. Its mechanism might be related to the decrease of ANP and TGF-beta1 and improvement of lipids metabolism and renal tubular interstitial pathological changes.</p>

Clinical observation on treatment of chronic allograft nephropathy with bailing capsule / 中国中西医结合杂志

<p><b>OBJECTIVE</b>To observe the effects of Bailing Capsule (BLC, a dry powder-formed preparation of Cordyceps sinensis mycelia) on chronic allograft nephropathy (CAN).</p><p><b>METHODS</b>A comparative synchronous study was conducted between 36 CAN patients treated with BLC 9.0 g/d (treated group) for 12 weeks and 15 CAN patients treated without BLC (control group). The changes of renal function, endogenous creatinine clearance rate, volume of urinary protein and urinary protein components, including immune globulin (Ig) and albumin (Alb), urinary retinol binding protein (RBP) and beta2-microglobulin (beta2-MG), as well as the incidence rate of leucopenia before and after treatment in the two groups were compared.</p><p><b>RESULTS</b>Compared with the control group, BLC showed more significant effects in lowering urinary protein (0.89 +/- 0.53 g/d in the treated group vs 1.31 +/- 0.59 g/d in the control group after treatment, the same below), serum creatinine (206.48 +/- 30.61 micromol/L vs 240.17 +/- 29.55 micromol/L), relieving glomerular and tubular proteinuria represented by levels of Ig, Al, RBP and beta2-MG in urine, increasing endogenous creatine clearance rate (37.33 +/- 9.91 ml/min vs. 31.92 +/- 10.95 ml/min), and reducing the incidence rate of leucopenia (2.8% vs 13.3%) in CAN patients.</p><p><b>CONCLUSION</b>BLC has certain therapeutical effect on CAN. It could relieve injury in glomerulus and tubular interstitium and has preventive and therapeutical effect on leucopenia.</p>

Diagnosis and therapy of the nutcracker phenomenon: long-term follow-up / 中华外科杂志

<p><b>OBJECTIVE</b>To study the diagnosis of adult nutcracker phenomenon (NCP) and assess the therapeutic value of endovascular stenting (ES) and superior mesentery artery transposition (SMAT) for the treatment of NCP in long-term follow-up.</p><p><b>METHODS</b>Six patients (6 men) aged 16 and 34 years old (mean age, 22.7 +/- 18.0 years) were diagnosed as having NCP using the examination of the doppler ultrasound and/or magnetic resonance of artery/digital radiography (MRA/DSA). Three patients underwent ES and 3 patients received SMAT for the treatment of the NCP patients associated with recurrent gross hematuria and left flank pain. Doppler ultrasound and urine examination were used at pre- and post-operation.</p><p><b>RESULTS</b>In 3 patients who underwent SMAT, the postoperative complications comprised retroperitoneal hematoma necessitating surgical revision (n = 1). Functional disorder of intestine (n = 1) and paralytic ileus (n = 1) that were resolved by conservative management. In 3 patients who experienced ES, 1 patient received surgical revision because the position of stent was not suitable in left renal vein but no other complication took place. During the follow-up of 6 approximately 50 months (mean 24.7 +/- 18.0 months), except that 1 patient's hematuria disappears at rest and reappears after motion while the other 5 patients remain asymptomatic and free of hematuria. The dopplar ultrasound showed the left renal vein diameters of the angel segment between superior mesentery artery and aorta were (0.18 +/- 0.05) cm preoperation and (0.65 +/- 0.17) cm postoperation, P < 0.001; the left renal vein diameters of the portal segment were (0.89 +/- 0.22) cm preoperation and (0.79 +/- 0.20) cm postoperation, P = 0.003; the left renal vein diameter's ratio between portal and angel segment were (4.99 +/- 0.79) preoperation and (1.23 +/- 0.16) postoperation, P < 0.001.</p><p><b>CONCLUSIONS</b>Dopplar ultrasound plays a very important role in the diagnosis of adult NCP. SMAT is an efficient surgical approach to the treatment of the nutcracker phenomenon and is associated with an acceptable risk of complications. But ES is safer and more efficient than SMAT and may represent a valuable approach to lessening the morbidity of surgical procedures. ES is a new therapeutic method for adult NCP.</p>