Falta de adherencia al control médico en pacientes pediátricos con antecedente de glomerulonefritis infecciosa

Introducción: La glomerulonefritis pos infecciosa (GNPI) en la infancia es un factor de riesgo para el desarrollo de enfermedad renal crónica a largo plazo. La adherencia al control médico permite realizar la nefroprevención secundaria. Objetivo: evaluar la relación entre los factores de riesgo relacionados a la falta de adherencia al control médico de pacientes con GNPI en una cohorte pediátrica. Metodología: estudio descriptivo de asociación cruzada de cohorte retrospectiva de pacientes internados entre enero de 2000 a diciembre de 2018 en un hospital de referencia. Se analizó la relación entre: hacinamiento, colecho, escolaridad materna y paterna, número de hermanos, de convivientes y procedencia, con la falta de adherencia al control médico. Se utilizaron la prueba de chi cuadrado y regresión logística a un nivel de significancia de 0,05. Resultados: Se incluyeron 148 pacientes (103 niños y 45 niñas) entre 2 a 16 años (edad promedio: 8,5± 3,4 años). La falta de adherencia fue encontrada en 73 pacientes (49,3%) que se asoció a procedencia rural (p= 0,012, RR: 1,50, IC95%: 1,10-2,06), baja escolaridad materna (p= 0,046, IC95%: 1,54:1,14-2,08), baja escolaridad paterna (p= 0,02; RR: 1,483, IC95%: 1,09-2,01), >3 convivientes (p=0,007, RR: 1,630, IC95%: 1,21-2,19), colecho (p=0,026; RR: 1,52, IC95%: 1,02-2,27) y hacinamiento (p<0,0001; RR: 1,92, IC95%: 1,39-2,65). Por regresión logística, el hacinamiento (p=0,005; OR= 4,8) y procedencia rural (p=0,022; OR: 2,4) se mantuvieron asociados a la falta de adherencia. Discusión: El hacinamiento y la procedencia rural se asociaron en forma independiente con la pérdida de seguimiento. Se recomienda mayor intervención de la atención primaria de salud.

Introduction: Post-infectious glomerulonephritis (PIGN) in childhood is a risk factor for the development of long-term chronic kidney disease. Adherence to medical control allows secondary nephroprevention to be carried out. Objective: to evaluate the relationship between risk factors related to non-adherence to medical control of patients with IPGN in a pediatric cohort. Methods: descriptive study, with an analytical component of a retrospective cohort of patients hospitalized between January 2000 and December 2018 in a reference hospital. The relationship between: overcrowding, co-sleeping, maternal and paternal education, number of siblings, cohabitants and origin, with lack of adherence to medical control was analyzed. The chi-square test and logistic regression were used at a significance level of 0.05. Results: a total of 148 patients (103 boys y 45 girls) between 2 and 16 years old (mean age: 8.5± 3.4 years) were included. The lack of adherence was found in 73 patients (49.3%) that was associated with rural origin (p= 0.012, RR: 1.50, 95% CI: 1.10-2.06), low maternal education (p= 0.046, 95%CI: 1.54:1.14-2.08), low paternal education (p= 0.02; RR: 1.483, 95%CI: 1.09-2.01), >3 cohabitants (p=0.007, RR: 1.630, 95% CI: 1.21-2.19), co-sleeping (p=0.026; RR: 1.52, 95% CI: 1.02-2.27) and overcrowding (p<0.0001; RR: 1.92, 95% CI: 1.39-2.65). By logistic regression, overcrowding (p=0.005; OR= 4.8) and rural origin (p=0.022; OR: 2.4) remained associated with lack of adherence. Discussion: Overcrowding and rural origin were independently associated with loss to follow-up. Greater intervention by primary health care is recommended.

Frecuencia y características de la encefalopatia hipertensiva secundaria a glomerulonefritis posinfecciosa en pacientes internados en un hospital de referencia nacional

Introducción: La glomerulonefritis aguda pos infecciosa (GNPI) puede cursar con complicaciones como la encefalopatía hipertensiva en 7-11% de los casos. Objetivo : determinar la frecuencia y características de la encefalopatía hipertensiva (EH) secundaria a GNPI en pacientes internados en el Departamento de Pediatría del Hospital Nacional en el periodo enero/2000-diciembre/2018. Materiales y Métodos : Estudio observacional, descriptivo, retrospectivo de pacientes con síndrome nefrítico (SN) con C3 disminuido y normalización a los tres meses, con hipertensión arterial (HTA) severa acompañada de manifestaciones neurológicas (cefalea, náuseas, vómitos, alteración de conciencia, convulsiones), que cedieron al regularizarse la HTA. Se estudiaron las características sociodemográficas (edad, sexo, procedencia, escolaridad de los padres, número de hijos) y clínicas (edema periférico, edema agudo de pulmón, hematuria, y manifestaciones neurológicas). Los datos fueron analizados utilizando estadística descriptiva mediante EPIINFO (CDC, Atlanta), expresando las variables cuantitativas como mediana y rango intercuartílico (RIC) y las cualitativas como frecuencia absoluta y porcentual. Resultados: 27 /160 (16,8%) pacientes, desarrollaron EH. La edad varió entre 3 a 16 años (mediana: 10 años; RIC: 5); el antecedente infeccioso más frecuente fue piodermitis (40,7%), seguido de faringitis aguda (37%). Todos los pacientes presentaron edema periférico y cefalea intensa. La duración de la HTA tuvo una mediana de 5 días (RIC: 4) y los días de internación una mediana de 7 (RIC: 6). Ningún paciente requirió diálisis ni quedó con secuelas, no se registraron óbitos. Conclusión: en pacientes con EH debe considerarse el diagnóstico de GNPI, investigando antecedentes infecciosos y valorando adecuadamente la volemia.

Introduction: Acute post-infectious glomerulonephritis (APGN) can present with complications such as hypertensive encephalopathy in 7-11% of cases. Objective: to determine the frequency and characteristics of hypertensive encephalopathy (HE) secondary to APGN in patients admitted to the Department of Pediatrics of the National Hospital from January/2000 to December/2018. Materials and Methods: This was an observational, descriptive and retrospective study of patients with nephritic syndrome (NS) with decreased C3 and normalization at three months, with severe arterial hypertension (AHT) accompanied by neurological manifestations (headache, nausea, vomiting, altered consciousness, seizures), which subsided when the AHT was controlled. Sociodemographic (age, sex, place of residence, parental education level, number of children in home) and clinical (peripheral edema, acute pulmonary edema, hematuria, and neurological manifestations) characteristics were studied. The data were analyzed using descriptive statistics through EPI INFO (CDC, Atlanta), expressing the quantitative variables as median and interquartile range (IQR) and the qualitative ones as absolute frequency and percentage. Results: 27/160 (16.8%) patients developed HE. Age ranged from 3 to 16 years (median: 10 years; IQR: 5); the most frequent infectious history was pyodermitis (40.7%), followed by acute pharyngitis (37%). All patients presented peripheral edema and severe headache. The duration of AHT had a median of 5 days (IQR: 4) and the days of hospitalization a median of 7 (IQR: 6). No patient required dialysis or was left with sequelae, no deaths were recorded. Conclusion: in patients with HE, the diagnosis of APGN should be considered, a history of infections obtained and adequately assessing fluid status.

Glomerulonefritis aguda posinfecciosa como riesgo para desarrollar insuficiencia renal crónica en una cohorte pediátrica de un hospital de referencia en Paraguay

Contexto: la glomerulonefritis aguda posinfecciosa (GNPI) representa un riesgo para el desarrollo de insuficiencia renal a largo plazo. Objetivo: describir la incidencia de proteinuria persistente y factores asociados en pacientes con antecedente de GNPI en una cohorte pediátrica de un hospital de referencia en Paraguay. Metodología: se incluyó a 121 pacientes con síndrome nefrítico con C3 disminuido, con normalización a los tres meses, aunque no se haya comprobado etiología estreptocócica. Se excluyó a los pacientes con enfermedad renal previa, con síndrome nefrítico secundario y con menos de seis meses de seguimiento. Se analizaron las características sociodemográficas, infecciones precedentes, aclaramiento de creatinina, días de hipertensión arterial y de internación, además de la relación de estas con la persistencia de proteinuria a los seis meses y más de seguimiento. Resultados: de los 121 pacientes entre 2 a 16 años de edad incluidos, 75 pacientes tuvieron un seguimiento médico entre 6 y 48 meses, de los cuales 43 (57,3 %) desarrollaron proteinuria persistente, la cual se asoció con un menor aclaramiento de creatinina (p = 0,03; 67,74 ± 25,69 mL/min/1,73 m2 SC vs. 80,22 ± 2,98 mL/min/1,73 m2 SC), con el número promedio de convivientes (6,3 ± 2,8 vs. 5,3 ± 2,3; p = 0,027) y el número promedio de hijos (4,3 ± 2,7 vs. 3,6 ± 2,3; p = 0,048). No se encontró asociación con las otras características. Conclusiones: la incidencia de proteinuria se asoció con un menor aclaramiento de creatinina y con una mayor frecuencia de los determinantes sociales en salud.

Background: Acute post-infectious glomerulonephritis (PIGN) represents a risk for the development of long-term renal failure. Purpose: To describe the incidence of proteinuria in patients with a history of PIGN in a pediatric cohort at a referral hospital in Paraguay. Methodology: a total of 121 patients with nephritic syndrome with decreased C3 and normalization at 3 months, although streptococcal aetiology has not been proven were included. Patients with with previous kidney disease, with secondary nephritic syndrome and with less than 6 months of follow up were excluded. Sociodemographic characteristics, previous infection, creatinine clearance, days of arterial hypertension and hospitalization were analyzed, in addition to their relationship with the persistence of proteinuria at 6 months and more of follow-up. Results: Of the 121 patients between 2 and 16 years of age included, 75 patients had a medical follow-up between 6 and 48 months, 43 (57.3 %) of them developed persistent proteinuria, which was associated with lower creatinine clearance (p = 0.03; 67.74 ± 25.69 mL/min/1.73 m2 BM vs 80.22 ± 2.98 mL/min/1.73 m2 BM), higher average number of cohabitants (6.3 ±2.8 vs 5.3±2.3; p= 0.027) and higher average number of children (4.3±2.7 vs 3.6±2.3; p= 0.048). No association was found with other characteristics. Conclusions: the incidence of proteinuria in this series was associated with lower creatinine clearance and a higher frequency of social determinants in health.

Takayasu arteritis associated with focal and segmentary glomerulosclerosis

Takayasu arteritis (TA) is a large vessel vasculitis that affects young people, related to cardiovascular outcomes and chronic kidney disease. We present the case of a 20-year-old male with a diagnosis of TA, who developed chronic kidney disease, impaired renal blood flow was ruled out, renal biopsy was compatible with focal and segmental glomerulosclerosis of a collapsing variety, other possible aetiologies were excluded. The mechanisms that mediate this association have not been determined, immune-mediated mechanisms are proposed. According to our review, this is the second reported case of this association and the first with a collapsing variety.

La arteritis de Takayasu es una vasculitis de grandes vasos que afecta a personas jóvenes y se relaciona con desenlaces cardiovasculares y enfermedad renal crónica. Se presenta el caso de un paciente masculino de 20 arios, con diagnóstico de arteritis de Takayasu, que desarrolla enfermedad renal crónica. Se descartan alteraciones en el flujo sanguíneo renal, en tanto que la biopsia renal resulta compatible con glomeruloesclerosis focal y segmentaria de variedad colapsante. Se excluyeron otras posibles etiologías. No se han determinado los mecanismos que median en esta asociación; se proponen mecanismos inmunomediados. Según nuestra revisión, se trata del segundo caso reportado de esta asociación y el primero con variedad colapsante.

Efficiency of Rituximab in treating children with refractory nephrotic syndrome / 中华实用儿科临床杂志

Objective:To assess the efficacy of Rituximab (RTX) in treating children with refractory nephro-tic syndrome.Methods:A retrospective study was carried out.Twenty-two children diagnosed with refractory nephrotic syndrome in the Department of Nephrology of Wuhan Children′s Hospital, Tongji Medical College, Huazhong University of Science and Technology from November 2018 to November 2020 were included in the study.All patients were treated with RTX.Patients with CD 19+ B lymphocytes≥1% total lymphocytes in peripheral blood were supplemented with one dose of RTX (375 mg/m 2), and each patient received 3-4 doses of RTX on average.The patients were treated with Mycophenolate mofetil after early discontinuation of calcineurin inhibitors (CNI). The Kaplan-Meier method was used to analyze the proteinuria relapse-free rate and the incidence of frequently recurrent nephrotic syndrome or steroid-dependent nephrotic syndrome in children after RTX treatment.The relapse times before and after using RTX were analyzed by the Wilcoxon signed rank test.Besides, the body mass indexes (BMI) and height of children before and after RTX treatment were compared by the rank sum test. Results:Of 22 patients studied, 20 patients accomplished the therapeutic protocol.One-year and two-year proteinuria relapse-free survival rates were 85% and 40%, respectively.The recurrence rate was reduced under the discontinuation of CNI.Compared with those before RTX treatment, the BMI and height of all children were significantly improved at 1 year and 2 years after RTX treatment (all P<0.05). However, no significant improvement was observed between 1 or 2 years after RTX treatment (all P>0.05). Conclusions:The use of RTX can effectively reduce the recurrence rate of refractory nephrotic syndrome even when hormones and other immunosuppressants are discontinued.At the same time, RTX can significantly improve the BMI and height of children.RTX is safe and effective for treatment of refractory nephrotic syndrome.

The bioinformatics analysis of gene methylation for children steroid resistance nephrotic syndrome / 中华肾脏病杂志

Objective Through selecting abnormal DNA methylation of children steroid resistance nephrotic syndrome and bioinformatics analysis to find the pathogenesis of steroid resistance nephrotic syndrome and provide new targets for therapy. Methods We use illumine 450K methylation chip to detected blood gene DNA methylation of 9 cases of children primary nephrotic syndrome. 9 cases were divided into 2 groups: G1 is the group of steroid sensitive nephritic syndrome, a total of 4 cases; G2 is the group of steroid resistance nephrotic syndrome, a total of 5 cases. Selected the abnormal DNA methylation in children steroid resistant nephritic syndrome, clarified the function of those genes through using functional annotation of gene GO, enrichment analysis and KEGG pathway analysis, conducted the preliminary analysis on children with steroid resistant nephrotic syndrome of gene methylation. Results Compared with the control group, G2 has a number of genes that were extensively methylated. According to the results of bioinformatics analysis, the abnormal DNA methylation in G2 is the components of the various kinds of organelles and cell membrane. They also regulated the polymerization and composition of cytoskeleton and actin, as well as involved in the process of metabolism of many amino acids and drug. Conclusions The abnormal DNA methylation in the group 2 have extensive role, offering possibility of clinical prediction and provided potential therapeutic targets.

Clinicopathological analysis on mercury poisoning-associated nephritic syndrome / 中国职业医学

OBJECTIVE: To explore the clinicopathological characteristics and therapeutic approach for mercury poisoningassociated nephritic syndrome. METHODS: Clinical and pathological data of 9 patients diagnosed with mercury poisoningassociated nephritic syndrome were analyzed. RESULTS: Among the 9 cases,2 cases were mercury smelters,1 case was instrument production worker,1 case was traditional Chinese medicine preparation worker,4 cases were psoriasis treated by folk prescription of traditional Chinese medicine,and 1 case used cosmetics for whitening and freckle removal. All cases showed clinical manifestation of nephritic syndrome that included large amount of proteinuria,hypoalbuminemia,edema and hyperlipidemia. The concentrations of urine mercury in the patients were from 0. 09 to 0. 75 mg / L before treatment.Pathology examination on renal biopsy showed that there were 4 cases of minimal change nephropathy and 5 cases of membranous nephropathy at stage Ⅰ. The patients with nephritic syndrome were cured after mercury driving and treatment with corticosteroid. CONCLUSION: The kidney histopathology changes in patients with mercury poisoning-associated nephritic syndrome are primarily characterized by minimal change and membranous nephropathy. The mercury driving combined treatment with corticosteroid can completely relieve the clinical symptoms of the patients with mercury poisoningassociated nephritic syndrome.

Analysis of clinical and pathological relationship of idiopathic membranous nephropathy in elderly patients / 中华老年医学杂志

Objective To understand the clinical and pathological characteristics of idiopathic membranous nephropathy,and to investigate their relationships in the elderly patients.Methods The clinical and pathological data of idiopathic membranous nephropathy diagnosed by renal biopsy in the recently 10 years in our hospital were retrospectively analyzed and compared.Results Sex composition variable was not significant between elderly and non-elderly groups,with male accounting for 57.4％ and 59.2％ respectively (P＞0.05).The ratio of idiopathic membranous nephropathy in primary glomerular disease was higher in the elderly than in non-elderly group (42.8％ vs.17.4％,x2 =119.058,P＜0.01).The course of the disease,the occurrence of edema,hypertension,levels of blood urea nitrogen,serum creatinine,blood IgG,IgA and IgG/IgM ratio were higher,while glomerular filtration rate and blood IgM level were lower in elderly group than in non-elderly group (all P＜0.05).The risk for membranous nephropathy was higher in elderly than in non-elderly group (Z=-5.853,P＜0.01).Nephrotic syndrome was common in the clinical diagnosis in the two groups,but it was more common in elderly group than in non-elderly group (x2 =6.825,P=0.033).Membranous nephropathy stage Ⅱ was common in the two groups,and there were no significant differences in the pathological stages,clinical manifestations and their relationships between the two groups (all P＞0.05).Conclusions The risk for idiopathic membranous nephropathy is higher in elderly group than in non-elderly group.Edema,hypertension and renal dysfunction occur more commonly in elderly patients with idiopathic membranous nephropathy.

Progress in common hereditary glomerular diseases / 医学研究生学报

Hereditary glomerular disease is an important part of kidney diseases .In recent years , hereditary glomerular disea-ses had a high incidence and poor prognosis .Thus, the studies involving hereditary glomerular diseases such as Alport syndrome , he-reditary nephritis syndrome and thin basement membrane disease , etc.have significant implications .This review mainly focuses on the pathogenesis , clinical features , diagnosis and treatment of Alport syndrome and hereditary nephritis syndrome .

Changes and clinical significance of serum cortisol and adrenocorticotrophic hormone levels in children with steroid-sensitive nephritic syndrome / 中华实用儿科临床杂志

Objective To investigate the changes in serum cortisol and adrenocorticotrophic hormone(ACTH) levels in children with steroid-sensitive nephritic syndrome (SSNS) and the clinical significance of intervention.Methods According to whether a child with SSNS would relapse,48 children with SSNS were divided into non-recurrence group(n =19) and recurrence group(n =29),at the same time 14 age-matched healthy children were enrolled as the healthy control group.Serum cortisol and ACTH were measured in patients with SSNS by using electrochemiluminesence methods.In recurrence group,methylpredisolone or methylprednisolone combined with ACTH injection therapy was used on 15 patients with their serum cortisol and ACTH below normal.Results Before standard glucocorticoid treatment,the serum levels of cortisol and ACTH had no difference among 3 groups (all P ＞ 0.05).By the end of remission phase,the serum levels of cortisol and ACTH in recurrence group were statistically lower than those of the non-recurrence group[(113.03 ± 80.02) μg/L vs (251.54 ± 185.05) μg/L,t =-2.925,P ＜ 0.05 ; (12.81 ± 10.14) ng/L vs (23.53 ± 12.05) ng/L,t =-0.885,P ＜ 0.05].Eight to 12 weeks after being adjusted,the serum level of cortisol and the average monthly time of recurrent were both significantly improved in 15 abnormal children in recurrence group [(168.90 ± 133.43) μg/L vs (73.62 ± 58.04) μg/L,t =3.016,P ＜ 0.05 ; (0.09 ± 0.08) times vs (0.35 ± 0.11) times,t =-7.560,P ＜0.05],but as to the serum level of ACTH,there was no significant difference in abnormal children in recurrence group [(14.05 ± 10.99) ng/L vs (8.72 ± 4.11) ng/L,t =1.991,P ＞ 0.05].Conclusions The concentrations of serum cortisol and ACTH can reveal the risk of recurrence for children with SSNS to some extent,and effective intervention can reduce the recurrence rate and shorten the course of disease.

Application progress of immunosuppresive agent in refractory nephritic syndrome in children / 国际儿科学杂志

Refractory nephrotic syndrome(RNS) is one of the main causes of end-stage renal disease to children and also a difficult issue in clinic treatment.In recent years,the emergence of new immunosuppresive agents greatly improved the prognosis of children with RNS.In this paper,the application progress of immunosuppresive agents such as cyclophosphamide,ciclosporin,tacrolimus,mycophenolate mofetil,leflunomide and rituximab which were commonly used in recent years to different types of children with RNS are summarized.

Clinical,pathologic and prognostic analysis in children with steroid-resistant nephritic syndrome / 重庆医学

Objective To study the features of clinic ,pathology and prognosis in children with steroid-resistant nephritic syn-drome(SRNS) .Methods Children with SRNS hospitalized in Division of Nephrology and Immunology in our hospital from January 2003 to December 2012 were analyzed retrospectively in clinic ,pathology and prognosis .Results 162 patients were investigated , which accounted for 10 .8% of children with Primary nephritic syndrome(PNS) ,and the mean age of onset was 6 .9 ± 3 .8 years old . Renal biopsy was performed in 132 patients ,60 of them showed mesangial proliferative glomerulonephritis(MsPGN) ,30 showed fo-cal segmental glomerulosclerosis(FSGS) ,19 showed minimal change disease(MCD) ,8 showed membranoproliferative glomerulone-phritis(MPGN) ,5 showed membranous nephropathy(MN) ,1 showed proliferative sclerosis glomerulonephritis(PSGN) .Patients with non-minimal change disease(non-MCD)had a significant prevalence of hematuria .The distribution of pathologic type among age groups and clinical classification was significantly different ,respectively(P<0 .05) .(2)132 patients were followed up ,58 of them were in complete remission ,26 were in partial remission ,15 were not in remission ,8 were dead ,and the mean time for com-plete remission was 15 months(3-84 .Prognosis correlated with pathologic type(P<0 .01) .Conclusion (1)There is a preponder-ance of non-MCD in children with SRNS ,and MsPGN and FSGS is the major pathologic type .Hematuria is a predictor of glucocor-ticoid resistance .(2)Children with SRNS have a long time proteinuria and poor prognosis .FSGS has a poor prognosis ,when com-pared with MsPGN .

Meta-analysis of tacrolimus on children with difficult nephritic syndrome / 中国小儿急救医学

Objective To evaluate the effects and safety of tarcrolimus on children difficult nephritic syndrome.Methods Databases including the Cochrane Library,Pubmed,Medline,OVID,CNKI,Wan Fang Data and VIP were searched to collect the controlled trials on tacrolimus capsule published from Jan 2003 to Jun 2013.The quality of the included randomized controlled trials was assessed by Jadad,and the complete remission,the fail,the relapsing rate of 12 month and side effects after treatment were extracted,meta-analysis was performed using RevMan 5.0 software.Results Among 179 articles,6 articles were included,4 of them were English and the other 2 were Chinese.The results of meta-analysis based on stratified therapeutic strategies showed that:(1) comparing with cyclophosphamide,tacrolimus could decrease the fail and relapsing rate of 12 month,but could not increase the complete remission (P ＞ 0.05).(2) Comparing with cyclosporine A,tacrolimus had no difference in complete remission and the relapsing rate of 12 month (P ＞ 0.05),but could decrease the fail.(3) Tacrolimus could increase the complete remission and decrease fail,but had no difference in relapsing rate (P ＞ 0.05).(4) There was no significant difference in relapsing rate between tacrolimus and rituximab(P ＞ 0.05).(5) Tacrolimus had less side effects than cyclophosphamide.Conclusion Tacrolimus have advantages to cyclophosphamide,cyclosporine A and prednisolone,but not to rituximab,and have less side effects than cyclophosphamide.

The changes of bone resorption in prednisone treatment of nephrotic syndrome and the intervention of α-D3 on it / 安徽医科大学学报

Objective To discuss the change of bone resorption of primary nephrotic syndrome (PNS) patients with prednisone treatment, andα-D3 effects on it. Methods ①30 PNS patients diagnosed and 28 healthy people in our hospital were selected;blood and urine samples before and after enough prednisone (pred) treatment were collect-ed to detect the iPTH, calcium and urinary DPD. ②30 PNS patients after 6 weeks enough prednisone treatment were randomly divided into Pred +α-D3 group and Pred group. Results ① PNS group compared with healthy group, urine DPD excretion rate was significantly increased(P<0.05),and blood iPTH was significantly increased (P<0.01);blood calcium was similar to healthy group. ② PNS patient after treatment with pred compared with that before treatment, urine DPD excretion rate was significantly increased(P<0.01),and blood iPTH was signifi-cantly increased(P<0.01). There was no obvious change in blood calcium.③Pred+α-D3 group compared with Pred group, urine DPD excretion rate was significantly decreased(P<0.01),and blood iPTH was significantly de-creased(P<0.05). There was no obvious change in blood calcium. Conclusion α-D3 can effectively reduce bone resorption in PNS patients.

Progress of immunologic derangement in the pathogenesis of primary nephritic syndrome / 国际儿科学杂志

Help T cell 1/Help T cell 2 and some cytokines disequilibrium can give a suitable explanation for hypersensitivity and hypogammaglobulinemia in primary nephritic syndrome(PNS) patients. The disturbance of regulatory T cell(Treg cell) and Th17 cell can lead to correlated cytokines derangement, which explained the pathogenesis of PNS from another aspect. Refractory nephrotic syndrome can be effectively treated by rituximab followed the percentage of regulatory T cell increasing, which indicated that Treg may play an important role in pathogenesis of PNS.

Tratamento com plasmaférese da glomerulosclerose segmentar focal recorrente após transplante renal. Relato de caso / Treatment with plasmapheresis of focal segmental glomerulosclerosis after kidney transplantation applicant. Case report

JUSTIFICATIVA E OBJETIVOS: A glomerulosclerose segmentar e focal (GESF) é uma doença progressiva e sem tratamento curativo, levando ao longo da sua progressão à insuficiência renal crônica (IRC) e a outras complicações, sendo a plasmaférese um dos poucos recursos terapêuticos. O objetivo deste estudo foi relatar um caso em que a plasmaférese terapêutica foi utilizada durante o acompanhamento do paciente, mostrando a recorrência da doença mesmo em uso contínuo da plasmaférese. RELATO DE CASO: Paciente do sexo masculino, 13 anos, diagnosticado com GESF e importante comprometimento da função renal, submetido a transplante com posterior rejeição e piora do quadro, sendo submetido à seções periódicas de plasmaférese frente a constante piora clínica e às poucas opções terapêuticas. CONCLUSÃO: Ainda controversa, a plasmaférese é indicada no tratamento da GESF recorrente. A intervenção precoce em pacientes transplantados com GESF recorrente é capaz de mudar o prognóstico ao longo da evolução para IRC. Neste paciente não apresentou resposta satisfatória ao tratamento, mesmo sendo realizadas sessões pré e imediatamente após o segundo transplante e ao longo de seu acompanhamento com o objetivo de diminuir a proteinúria e a recorrência.

BACKGROUND AND OBJECTIVES: Focal segmental glomerulosclerosis (FSGS) is a progressive disease without curative treatment, bringing along their progression to chronic renal failure (CRF) and other complications, plasmapheresis one of the few therapeutic resources. The aim of this study was to report a case in which the plasma therapy was used during the monitoring of the patient showing recurrence of disease even in continuous use of plasmapheresis. CASE REPORT: Male patient, 13 years, diagnosed with FSGS with significant renal disease underwent renal transplant rejection and subsequent worsening of symptoms, underwent plasmapheresis front sections of the periodic steady worsening clinical and few therapeutic options. CONCLUSION: Still controversial, plasmapheresis is indicated for the treatment of FSGS. Early intervention in transplant patients with recurrent FSGS is capable of changing the prognosis during the evolution to CRF. The patient showed no satisfactory response to treatment with plasmapheresis, although sessions held before and immediately after the second transplant and throughout their follow in order to reduce proteinuria and the recurrence.

Therapeutic observation on the treatment of proteinuria in nephrotic syndrome with Wenshen Xiaobai decoction / 国际中医中药杂志

Objective To observe the effects of Wenshen Xiaoban decoction treating proteinuria in nephrotic syndrome and its adverse reactions. Methods A total of 98 patients with proteinuria who were diagnosed of Yang deficiency of both spleen and kidney by TCM were randomly recruited into a control group (38 patients) and a treatment group (60patients). The treatment group was treated with Wenshen Xiaobai decoction, while the control group was treated with Shenyan Siwei tablets. 24h urine protein, serum albumin (Alb), blood urea nitrogen (BUN), serum creatinine (Scr), and the changes in clinical symptoms were observed before and after the treatment in both groups. Results The treatment group showed better results in 24 hours' urine protein, BUN, Scr, Alb and clinical symptoms than the control group, the difference showing statistical significance(P＜0.05). Conclusion Wenshen Xiaobai decoction can decrease proteinuria and improve renal function and clinical symptoms in NS patients belonging to Yang deficiency of both spleen and kidney.

Two Cases of Nephrotic Syndrome with Rapid Response to Saireito : Minimal Change and Membranous Nephropathy / 日本東洋医学雑誌

We report two cases of nephrotic syndrome successfully treated with saireito. The first patient developed massive proteinuria of 5.2 g/day, was diagnosed with minimal-change nephrotic syndrome upon renal biopsy, and rapidly improved with saireito treatment for 2 months to the reduced urinary protein level of 0.3 g/day. Urinary protein increased to 2.0 g/day just after discharge, then again decreased and was brought to remission soon thereafter. The second patient with biopsy-proven idiopathic membranous nephropathy maintained nephrotic syndrome remission for 8 years with the treatment of small-dose prednisolone, an immunosuppressant, and an angiotensin II receptor blocker, then relapsed with 4.4 g/day proteinuria. In this patient, proteinuria was reduced after 4 weeks with the above combination therapy plus saireito to 1.3 g/day, then remitted again soon thereafter. The former patient presented with mild discomfort and opposition when the subcostal region was pressed ; the latter patient presented with apparent discomfort and opposition together with moderate leg edema. Because rapid remission of massive urinary protein with saireito treatment was observed in these patients, we report here and discuss possible mechanisms.

Estudio comparativo entre nifedipina y captopril en crisis hipertensiva en niños / Nifedipine and captopril in hypertensive crisis in children

Introducción: La crisis hipertensiva es una urgencia pediátrica que se debe manejar con medicamentos de rápida acción, de fácil administración y sin mayores efectos secundarios. El medicamento usado tradicionalmente ha sido el nitroprusiato de sodio endovenoso en infusión continua lo que implica hospitalización en cuidados intensivos con mayores costos y riesgos. Objetivos: Comparar la eficacia y seguridad de la nifedipina y el captopril sublingual en crisis hipertensivas. Material y métodos: Se llevó a cabo un estudio prospectivo en niños entre 1 y 12 años de edad que ingresaron al servicio de pediatría urgencias del Hospital Universitario del Valle en Cali, Colombia, con diagnóstico de crisis hipertensiva. Se realizó monitoreo de la presión arterial sistólica, diastólica y media y de la frecuencia cardíaca antes de administrar los medicamentos y a los 5, 15, 30, 60, 120, 180, 240, 300 y 360 minutos después de administrados. Los dos medicamentos se dieron por vía sublingual a dosis de 0.2 mg/kg. Se vigilaron efectos secundarios después de su administración. Resultados: Durante 16 meses ingresaron 21 pacientes, 10 asignados a nifedipina y 11 a captopril, 13 niños y 8 niñas, con un promedio de edad de 7 años. La reducción de la presión arterial por debajo del percentil 95 inducida por la nifedipina sublingual fue más rápida, en promedio a los 20 minutos, que con captopril (50 minutos). Hasta los 30 minutos las cifras de presión arterial sistólica, diastólica y media fueron estadísticamente inferiores con nifedipina que con captopril, para luego tener una actividad muy similar. Se necesitó una segunda dosis en tres pacientes con nifedipina y uno con captopril. No hubo respuesta en dos pacientes con captopril. No se presentaron efectos secundarios mayores. Con la nifedipina se observó aumento promedio de 10% en la frecuencia cardíaca a los 5 minutos después de ser administrada.

Introduction: Hypertensive crisis is a pediatric emergency which implies medications with fast action and minimal side effects. Sodium nitroprusiate in continuous infusion has been the treatment of choice but implicates admission to intensive care unit. Objectives: To evaluate efficacy and safety of nifedipine and captopril in hypertensive crisis in children. Methodology: A prospective study was performed to evaluate efficacy and safety of sublingual nifedipine and captopril, in children 1-12 years old who were admitted with diagnosis of hypertensive crisis, to the Pediatric Emergency Service at the University Hospital in Cali, Colombia. Systolic, diastolic, mean blood pressure and heart rate were monitored in all patients before administration of the medicaments, time 0, and after the administration at time 5, 15, 30, 60, 120, 180, 240, 300, and 360 minutes. Side effects were observed carefully after the administration. Results: During a period of 16 months, 21 patients were enrolled in the study: 10 were assigned to nifedipine and 11 to captopril; 13 were boys and 8 were girls, with a mean age of 7 years old. Both medications were given sublingual at 0.2mg/kg/dose. Blood pressure reduction under 95 percentil induced by sublingual nifedipine was faster, mean time 20 minutes compared to captopril (50 minutes). Up to 30 minutes post medication systolic, diastolic and mean blood pressure were statistically lower with nifedipine than with captopril; but after 30 minutes both medications had similar activity. Three patients with Nifedipine and 1 with captopril required a second dose. Two patients with captopril had no response. No side effects were registered in either group. Nifedipine induced a 10% asymptomatic heart rate increase at 5 minutes after its administration, captopril did not increase heart rate.

Changes of Activity of Peripheral Blood Mononuclear Cells Nuclear Factor-?B in Children with Primary Nephrotic Syndrome and the Invention of Astragalus / 实用儿科临床杂志

Objective To investigate the pathogenesis of peripheral blood mononuclear cells(PBMC) nuclear factor kappa-?B(NF-?B) in children with primary nephritic syndrome(PNS) and the effect of astragalus on the activity of NF-?B.Methods Twenty-five children with PNS and 20 normal children were studied.Isolated PBMC were separated from 5 mL venous blood in asepsis condition.NF-?B stimulator,NF-?B inhabitor and astragalus were added into the different tubes of PBMC,respectively.The nuclear protein was extracted from the pellets and the optical density(A) values of nuclear protein was measured by enzyme-linked immunosorbent assay(ELISA).Results The activity of PBMC NF-?B in PNS group was higher than that in normal group(P0.05).Astragalus could decrease the activity of PBMC NF-?B which had been stimulated by interleukin-1?(IL-1?)(P