Clinical study of a low-dosed urokinase combined with fosinopri plus leflunomide on treatment of moderate and severe IgA nephropathy / 中国综合临床

ABSTRACT

Objective To investigate the effect and safety of a low-dosed urokinase combined with fosinopri plus leflunomide and prednisone on treatment of moderate and severe IgA nephropathy (IgAN).Methods Fifty-seven patients with IgAN confirmed by biopsy combining with clinical presentations were enrolled,with their ages ranged from 15 to 55,proteinuria excretion ≥ 1.0 g/24 h,serum creatinine (SCr) ≤ 265.20 μmol/L,grade Ⅲ or above in Hass histologic grading systems for renal biopsy.The patients were randomly divided into trial group( n =28 ) and control group( n =29 ) and received treatment for six months.The patients in trial group were treated with a low-dosed urokinase combined with fosinopri plus leflunomide and prednisone,while those in control group were treated with prednisone and fosinopril.Results ( 1 ) After 6 months of treatment,the rates of complete remission (CR) and partial remission (PR) were 52.0％ and 40.0％ respectively in trial group,and 20.8％ and 54.2％ respectively in control group.The total remission rate(TR)and CR in trial group were significantly higher than those in control group ( TR x2 =0.47,P ＜ 0.05 ; CR x2 =5.11,P ＜ 0.05 ).( 2 ) The SCr level was decreased in trial group ( [ 115.83 ± 16.78 ] μmol/L v.s.(93.29 ±12.41 ) μmol/L,P ＜ 0.05 ),while increased in control group ( [ 112.79 ± 12.79 ] μmol/L v.s.( 136.99 ±25.97 )μmol/L,P ＜ 0.05 ).The two groups had significant difference on SCr clearance rate after treatment( P ＜0.05).There was no significant difference between the two groups on the endogenous creatinine clearance rate (Ccr) ( P =0.52 ),and no significant difference within trial group ( [ 79.34 ± 6.09 ] ml/min v.s.[ 85.12 ±12.26] ml/min,P =0.05)and within control group( [80.18 ±6.51 ] mi/min v.s.[84.22 ±8.39] ml/min,P =0.67 ).The levels of 24-hour proteinuria excretion after 6 months were decreased in both groups ( trial group[1.93 ±0.55]g/24 hv.s.[0.78 ±0.42]g/24 h,P＜0.05;control group[1.85 ±0.51]g/24 h v.s.[1.30±0.35 ] g/24 h,P ＜ 0.05 ),and the treatment effect was better in trial group ( P =0.04 ).Conclusion Treatment of moderate and severe IgA nephropathy with low-dosed urokinase combined with fosinopri plus leflunomide and prednisone is effective and safe by improving renal function and decreasing proteinuria.