Effects of adjuvant therapy with low molecular weight heparin on nephrotic syndrome in 32 cases / 中国基层医药

Objective:To investigate the clinical efficacy of adjuvant therapy with low molecular weight heparin on nephrotic syndrome.Methods:Sixty-four patients with nephrotic syndrome who received treatment in Linyi People's Hospital between January 2018 and January 2020 were included in this study. They were randomly assigned to receive either conventional treatment combined with low molecular weight heparin treatment (observation group, n = 32) or conventional treatment (control group, n = 32) for 28 successive days. Before and after treatment, renal function indexes, blood lipid, coagulation function indexes, clinical efficacy, and adverse reactions were compared between the two groups. Results:After treatment, serum creatinine, urea nitrogen, 24-hour urinary protein, total cholesterol and triacylglycerol levels in the observation group were (109.21 ± 9.81) μmol/L, (5.35 ± 1.01) mmol/L, (1.12 ± 0.25) g/L, (5.12 ± 1.09) mmol/L, (1.52 ± 0.18) mmol/L, respectively, which were significantly lower than those in the control group [(120.54 ± 9.72) μmol/L, (6.05 ± 0.95) mmol/L, (1.42 ± 0.28) g/L, (6.92 ± 1.15) mmol/L, (1.96 ± 0.22) mmol/L, t = 4.641, 2.855, 4.521, 6.426, 8.756, all P < 0.05]. The activated partial thromboplastin time and prothrombin time in the observation group were (1.52 ± 0.18) seconds and (14.57 ± 1.70) seconds, respectively, which were significantly longer than those in the control group [(31.02 ± 4.59) seconds, (12.62 ± 1.67) seconds, t = -4.388, -4.628, both P < 0.05]. Total effective rate in the observation group was significantly higher than that in the control group [96.88% (31/32) vs. 75.00% (24/32), χ2 = 6.335, P < 0.05]. The time to relief of symptom in the observation group was significantly shorter than that in the control group [(3.12 ± 1.42) weeks vs. (5.04 ± 1.24) weeks, t = -5.761, P < 0.05). The incidence of adverse reactions in the observation group was significantly lower than that in the control group [3.13% (1/32) vs. 21.88% (7/32), χ2 = 5.143, P < 0.05]. Conclusion:Based on conventional treatment, adjuvant therapy with low molecular weight heparin for nephrotic syndrome can greatly improve clinical symptoms, increase clinical efficacy, and decrease the incidence of adverse reactions.

Nephrotic syndrome after insect sting: a case report / Síndrome nefrótica após picada de inseto: relato de caso

ABSTRACT Minimal change disease accounts for up to 25% of the cases of nephrotic syndrome in adult population. The allergic mechanism has been associated with minimal change disease and allergens have been implied, namely insect stings. We present a case report of a woman with new onset of nephrotic syndrome after a non-hymenoptera insect sting, with biopsy-proven minimal change disease, that was accompanied by a pulmonary thromboembolism process. Complete remission with glucocorticoid therapy was observed, with sustained response for 6 months after discontinuation. A new exposure to insect sting in the same geographical region and season triggered a nephrotic syndrome relapse. Subsequent avoidance of the place resulted in a sustained remission for more than 4 years.

RESUMO A doença de lesões mínimas é responsável por até 25% dos casos de síndrome nefrótica na população adulta. O mecanismo alérgico tem sido associado à doença de lesão mínima a associada a alérgenos, como picadas de insetos. Apresentamos um caso de uma mulher com início recente de síndrome nefrótica após picada de inseto não himenóptero, com doença de lesões mínimas comprovada por biópsia, acompanhada por um processo de tromboembolismo pulmonar. A paciente teve remissão completa com glicocorticoides, com resposta sustentada por 6 meses após a interrupção do tratamento. Uma nova exposição à picada de inseto na mesma região geográfica e estação do ano provocou uma recaída da síndrome nefrótica. Evitar o local subsequentemente resultou em remissão sustentada por mais de 4 anos.

Nefropatía por C1q: una rara variedad de síndrome nefrótico: caso clínico / C1q nephropathy: report of one case

C1q nephropathy is a rare glomerulopathy characterized by mesangial deposition of the complement component C1q. These deposits can be isolated or associated with immunoglobulins or complement fractions, which are observed by immunofluorescence or immunohistochemical microscopy. In ultramicroscopy, dense mesangial deposits and alterations of the podocyte are observed. Clinically it presents as a nephrotic syndrome (NS) or by alterations of the urinalysis such as proteinuria and/or hematuria in children and young adults. In light microscopy, it is expressed with a morphological pattern of minimal change disease (MCD), mesangial proliferative glomerulonephritis or focal segmental glomerulosclerosis (FSGS). The NS during its evolution usually evolve in steroid resistance or steroid dependency, often requiring the association of immunosuppressants to obtain remission. We report a 14 years old male with a history of NS and its evolution under various treatments during a 12-year follow-up.

Effect of glucocorticoid combined with cyclophosphamide in the treatment of primary IgA nephropathy with nephrotic syndrome and renal insufficiency / 中国基层医药

Objective To explore the effect of glucocorticoid combined with cyclophosphamide ( cytoxan, CTX) for the treatment of primary immunoglobulin A nephropathy ( IgAN ) with nephrotic syndrome and renal insufficiency .Methods 70 IgAN patients with nephrotic syndrome and renal insufficiency were selected as the research subjects,According to randomized single blind ,the patients were randomly divided into two groups ,35 cases in each group .The control group was treated with glucocorticoid ,the observation group was treated with glucocorticoid and cyclophosphamide combination therapy .The renal function indicators ,24 hour urine protein level ,serum albumin level,the occurrence of adverse reactions were compared between the two groups .Results After treatment, the endogenous creatinine clearance rate and glomerular filtration rate of the two groups were not decreased compared with before treatment (t =0.368,0.186,0.234,0.200,all P >0.05),the 24 hour urinary protein were decreased significantly (t=4.417,9.576,all P<0.05),serum albumin levels were significantly increased (t=5.922,9.433, all P<0.05).After treatment,the endogenous creatinine clearance rate [(16.23 ±7.57) mL/min,(16.09 ± 7.69)mL/min],glomerular filtration rate [(37.12 ±9.52) mL/min,(37.64 ±9.67) mL/min] between the two groups had no statistically significant differences (t=0.077,0.227,all P>0.05).After treatment,the 24 -hour urinary protein level and serum albumin level of the observation group [(1.18 ±0.30)g,(36.24 ±2.39)g/L]were better than those of the control group[(1.50 ±0.27)g,(33.92 ±2.07)g/L,t=4.691,4.341,all P<0.05].During the treatment, the incidence rate of adverse reactions in the observation group ( 25.71％) had no statistically significant difference compred with that in the control group (22.86％) (χ2 =0.078,P>0.05).Conclusion For IgAN patients with nephrotic syndrome and renal insufficiency , glucocorticoid combined with cyclophosphamide can reduce the urine protein ,increase serum albumin concentration to a certain extent ,but it has no obvious effect on renal function,and the adverse reaction is more serious than the single use of glucocorticoids .

Clinical observation on combined treatment of chronic nephritis proteinuria,a report of 22 cases / 中国基层医药

Objective To observe the curative effect of Zhengqingfengtongning release tablets and lumbroki-nase enteric -coated capsules and losartan potassium tablets joint for the treatment of chronic nephritis proteinuria, and explore its mechanism.Methods 42 patients with chronic nephritis were randomly divided into two groups. 20 cases in the control group were given losartan potassium tablets,50mg,1 ~2 times a day.22 cases in the treatment group received Zhengqingfengtongning release tablets 120mg,2 times a day,lumbrokinase enteric -coated capsules 600 000u,3 times a day on the basis of the control group.The 24h urine protein,liver and kidney function before and after the treatment were observed.Results 20 days after treatment,24h urinary protein in the treatment group decreased 57.08%,which in the control group decreased 41.59%,the difference was statistically significant (t =2.39,P <0.05).30 days after treatment,24h urinary protein in the treatment group decreased 81.28%,which in the control group decreased 52.34%,the difference was statistically significant (t =3.65,P <0.01 ).Renal function change had no significant difference between the two groups.Conclusion Zhengqingfengtongning release tablets and lumbrokinase enteric -coated capsules combined with losartan potassium tablets in the treatment of chronic nephritis proteinuria work fast,and has good curative effect,less side effects,and is worth to recommend.

Successfully Treated Femoral Artery Thrombosis in a Patient with Minimal Change Nephrotic Syndrome / 전남의대학술지

In contrast to widely recognized venous thrombotic complications, peripheral arterial thrombosis as a complication of nephrotic syndrome, especially without preceding iatrogenic venous puncture, corticosteroid treatment, or coagulation factor abnormalities, has rarely been reported in adult female patients. We report the case of a 39-year-old woman who presented with pain in the right lower leg accompanied by minimal change nephrotic syndrome. Lower-extremity angiography showed total occlusion of the right superficial femoral artery. Thrombectomy was performed with a balloon catheter, and the thrombi were successfully aspirated. Our experience indicates that even if few traditional risk factors for atherosclerosis are identified, a high index of suspicion and aggressive treatment of arterial thrombosis in adult nephrotic syndrome are crucial to minimize serious ischemic injuries.

Successfully Treated Femoral Artery Thrombosis in a Patient with Minimal Change Nephrotic Syndrome / 전남의대학술지

In contrast to widely recognized venous thrombotic complications, peripheral arterial thrombosis as a complication of nephrotic syndrome, especially without preceding iatrogenic venous puncture, corticosteroid treatment, or coagulation factor abnormalities, has rarely been reported in adult female patients. We report the case of a 39-year-old woman who presented with pain in the right lower leg accompanied by minimal change nephrotic syndrome. Lower-extremity angiography showed total occlusion of the right superficial femoral artery. Thrombectomy was performed with a balloon catheter, and the thrombi were successfully aspirated. Our experience indicates that even if few traditional risk factors for atherosclerosis are identified, a high index of suspicion and aggressive treatment of arterial thrombosis in adult nephrotic syndrome are crucial to minimize serious ischemic injuries.

A Case of Minimal Change Disease Treated Successfully with Mycophenolate Mofetil in a Patient with Systemic Lupus Erythematosus

The World Health Organization classifies lupus nephritis as class I to V or VI. However, a few cases of minimal change glomerulopathy have been reported in association with systemic lupus erythematosus (SLE). Mycophenolate mofetil has been shown to be effective for treatment of minimal change disease and lupus nephritis. A 24-year-old woman diagnosed with SLE five years prior to presentation complained of a mild generalized edema. The urinalysis showed microscopic hematuria and proteinuria. The assessed amount of total proteinuria was 1,618 mg/24 hours. A renal biopsy demonstrated diffuse fusion of the foot processes of podocytes on electron microscopy. Mycophenolate mofetil was started in addition to the maintenance medications of prednisolone 10 mg/day and hydroxychloroquine 400 mg/day. After six months of treatment, the microscopic hematuria and proteinuria resolved, and the total urine protein decreased to 100 mg/24 hours.

Clinicopathological analysis of mercury poisoning-associated glomerulonephropathy / 中华肾脏病杂志

Objective To elucidate the clinical and pathological characteristics of patients with mercury poisoning-associated glomerulonephropathy. Methods Seven patients with mercury poisoning-associated glomerulonephropathy were enrolled in this study. The pattern of mercury exposure, feature of mercury toxicity, and clinicopathological presentation of the kidneys were investigated. Results They were all female, averaged (28.9 ±8.1) years old. Skin-whitening cream was the only cause of mercury poisoning. Proteinuria occurred 5 to 8 months after exposure. Serum mercury were 27.0 to 98.0 μg/L, and spot urinary mercury were 34.4 to 204.0 μg/L. The presentation of all the patients was mild to moderate edema with proteinuria and decreased serum albumin level. Five patients (5/7) were diagnosed as nephrotic syndrome. Six patients underwent renal biopsy: 3 cases with minimal change disease, 2 cases with membranous nephropathy and 1 case with focal segmental glomerular sclerosis. All the patients were administrated chelation therapy with sodium dimercaptopropanal sulfonate or sodium dimercaptosuccinic acid for 3 to 7 courses. They got complete remission by 3 to 5 weeks treatment. Conclusions Patients in this study with glomerulonephropathy induced by mercury poisoning are all from skin-whitening cream exposure. Mild to moderate edema and proteinuria are the common clinical pattern. Minimal change disease, membranous nephropathy and focal segmental glomerular sclerosis are found pathologically. Chelation therapy is effective.

Clinicopathologic Characteristics of IgA Nephropathy with Steroid-responsive Nephrotic Syndrome

Nephrotic syndrome is an unusual manifestation of IgA Nephropathy (IgAN). Some cases respond to steroid treatment. Here we describe a case-series of IgAN patients with steroid-responsive nephrotic syndrome. Twelve patients with IgAN with steroidresponsive nephrotic syndrome were evaluated and followed up. All patients presented with generalized edema. Renal insufficiency was found in two patients. The renal biopsy of eight patients revealed wide foot process effacement in addition to the typical features of IgAN. They showed complete remission after steroid therapy. Seven relapses were reported in five patients; six of the relapsed cases responded to steroid therapy. Compared with steroid-non-responsive patients, the patients with steroid-responsive nephrotic syndrome had shorter symptom duration, more weight gain, more proteinuria, and lower histologic grade than did those that had steroid-non-responsive nephrotic syndrome at presentation. None of the responders progressed to end stage renal disease, whereas five (38%) non-responders required dialysis or renal transplantation. Patients with IgAN who have steroid-responsive nephrotic syndrome likely have both minimal change disease and IgAN. The clinical features of sudden onset of generalized edema, initial heavy proteinuria and initial severe hypoalbuminemia might help identify the subset of patients, especially in low grade IgAN.

Mycophenolate mofetil combined with low dose prednisone in the treatment for adults with minimal change nephrotic syndrome and concomitant HBsAg positive / 中华肾脏病杂志

Objective To assess the safety and efficacy of mycophenolate mofetil (MMF) combined with low dose corticosteroid in the treatment of adults with minimal change nephrotic syndrome and concomitant HBsAg positive (MCNS-HBsAg). Methods Thirty adults with MCNS-HBsAg were enrolled in this prospective study and were assigned to two groups. The MMF group (n=14) received low dose of prednisone combined with MMF (MMF 1.0 to 2.0 g/d patients of Pred group versus 35.7% patients of MMF group. 43.8% patients of Pred group versus 21.4% patients of MMF group received lamivudine therapy. Elevation of alanine aminotransferase(ALT) ocurred in 50% patients of Pred group and 28.6% patients of MMF group. The complete remission (CR) rate after 24 weeks treatment was 11/14 in Pred group versus 10/12 in MMF group. 6/11 patients of the Pred group and 4/10 patients of the MMF group who achieved CR experienced relapses during follow-up. Conclusions Use of MMF combined with low dose prednisone is as effective as conventional prednisone regimen in treating adults with MCNS-HBsAg. The MMF protocol seems to be superior in HBV reactivation to conventional prednisone protocol.

Effect of urinary IgG from nephrotic patients on expression of macrophage migration inhibitory factor in human proximal tubular epithelial cells / 中华肾脏病杂志

Objective To investigate the effect of purified urinary IgG from patients with minimal change nephrotic syndrome and membranous nephropathy on the expression of macrophage migration inhibitory factor (MIF) in human proximal tubular epithelial cells (HK-2). Methods Proteins were precipitated from urine with (NH4)2SO4, and urinary IgG was purified by protein G column chromatography. SDS-PAGE and Western blotting were performed to analyze the urinary IgG. HK-2 cells were incubated with urinary IgG (0,0.5,1.0,2.5,5.0,10.0 mg/ml) from either minimal change nephrotic or membranous nephropathy patients. The expression of MIF mRNA was assessed by RT-PCR, and MIF protein was assessed by Western blotting. Results SDS-PAGE showed that there were four bands, which were all IgG fractions confirmed by Western blotting. The urinary IgG up-regulated the expression of MIF mRNA and protein in HK-2 cells. The expression increased in a dose-dependent manner. The expression of MIF mRNA and protein in HK-2 cells increased significantly when they were incubated with urinary IgG from membranous nephropathy patients at 1mg/ml (P

Relationship of Membrane Glucocorticoid Receptors in Peripheral Blood Lymphocytes from Minimal Change Nephrotic Children and Influence of Glucocorticoid on Apoptosis and Proliferation / 实用儿科临床杂志

Objective To study the expression of membrane glucocorticoid receptors(mGR), the correlation between mGR and glucocorticoid(GC)'s effects on apoptosis and proliferation of peripheral blood lymphocytes(PBLs) in minimal change nephrotic syn-drome(MCNS)and the influence of GC on mGR. Methods MCNS, nonminimal change NS(NMCNS) and healthy children were involved in this study. Indirect immune fluorescence and flow cytometry were used to examine the percentages of positive mGR lymphocytes; the apoptosis of PBLs was measured by propidium iodide(PI) staining and the proliferation of PBLs was investigated by fa -TdR incorporation. Results 1.mGR expression in MCNS was higher than that in NMCNS and healthy control,but it was reduced after clinical GC therapy(P

Altered Expression of Nephrin, Glomerular Epithelial Cell Protein-1 (GLEPP1) and WT-1 in Glomerular Disease

BACKGROUND: Glomerular epithelial cell protein-1 (GLEPP1) and WT-1 expressed in mature visceral glomerular epithelial cell (VGEC) is required for maintenance of the mature status of VGEC. Nephrin protein is located at the filtration slit and regarded as a molecular component of the slit diaphragm. Alterations of these proteins in proteinuric diseases are not clearly defined. METHODS: We investigated the expression of GLEPP1, WT-1 and nephrin in 28 renal biopsies diagnosed with minimal change nephropathy (n=10), focal glomerulosclerosis (n=10) and membranous nephritis (n=8) by immunohistochemical staining. Normal control biopsies were obtained from six nephrectomy specimens. RESULTS: The patients consisted of 15 males and 13 females. The mean age was 40.7 years. Nephrotic range proteinuria (> or =3.5 g/day) was noted in 15 (54%) patients. GLEPP1 and nephrin expression were significantly decreased in patients as compared with those of the controls (p<0.05). The mean number of WT-1 expressing cells per glomerulus was also significantly decreased in patients as compared with those of the controls (p<0.05). However, there was no significant difference in the number of WT-1 expressing cells among the disease groups. CONCLUSIONS: These results suggest that the loss of biological markers of mature VGEC may play an important role in the pathogenesis of proteinuria.

Expression of ANGPTL3 in children with primary nephrotic syndrome / 中华肾脏病杂志

Objective To examine the expression of angiopoietin-like protein(ANGPTL)3 in kidneys from children with primary nephrotic syndrome. Methods Immunohistochemistry for ANGPTL3 was performed in kidney biopsies from patients with nephrotic syndrome or hematuria, including MCD (n=31), MN(n=6), FSGS (n=6), TBMN (n=10), IgA nephropathy (IgAN) with mesangial proliferation (n=16). Normal renal tissue of 2 cases with nephrectomy for tumor were used as control. According to the episode, four groups were divided ("12 months"). The expression was quantitatively examined with IMS color image analysis system, using positive index (PI) as sediment degree of ANGPTL3 in glomeruli or tubules. Immunofluorescence for ANGPTL3 co-labeling with WT1 and perlecan was applied to show the distribution of ANGPTL3. Results (1) The PI levels of ANGPTL3 in glomeruli of MCD(7.49?1.96) and MN (6.27?0.98) were significantly higher than those of TBMN (0.02?0.001), FSGS (3.14?0.49) or normal control(0.02?0.001) respectively (all P