Combination therapy with lamivudine and angiotensin-converting enzyme inhibitor/angiotensin receptor blocker for hepatitis B virus-associated glomerulonephritis with mild to moderate proteinuria: a clinical review of 38 cases.

PURPOSE: The treatment of HBV-associated glomerulonephritis (HBV-GN) is still a challenge in clinical practice now. The objective of this study was to report the pathological characteristics of HBV-GN presenting with mild to moderate proteinuria and to evaluate the therapeutic efficacy of lamivudine (LAM) in combination with angiotensin-converting enzyme inhibitor (ACEI)/angiotensin receptor blocker (ARB) as compared to ACEI/ARB monotherapy. METHODS: We conducted a retrospective observational study in HBV-GN patients between 2005 and 2014. The patients were classified into two groups: Group 1 included patients treated with LAM plus ACEI/ARB (n = 20), and group 2, patients treated with ACEI/ARB alone (n = 18). Their clinical and pathological characteristics were collected; we analyzed the therapeutic responses and assessed the correlation between renal and liver pathologies. RESULTS: Our results showed that the most common type of HBV-GN was IgA nephropathy. LAM plus ACEI/ARB therapy was better in reducing 24-h urinary protein excretion, alanine aminotransferase, and aspartate aminotransferase levels, while maintaining the level of kidney function. The proportion of patients who achieved remission (CR + PR) was higher in the LAM plus ACEI/ARB group than in the ACEI/ARB monotherapy group (χ 2 = 5.371, P = 0.035). CONCLUSION: In the HBV-GN patients with mild to moderate proteinuria, LAM plus ACEI/ARB not only improved liver function but also better reduced 24-h proteinuria.

[Effects of salvianolate combined with alprostadil and reduced glutathione on progression of chronic renal failure in patients with chronic kidney diseases: a long-term randomized controlled trial].

BACKGROUND: Effects of traditional Chinese medicine salvianolate combined with alprostadil and reduced glutathione on delay of progression in patients with acute kidney injury has been confirmed, but the role of this combination therapy on the progression of chronic renal failure is uncertain. OBJECTIVE: To investigate the long-term effects of regular administration of salvianolate combined with Western medicine on the progression of chronic renal failure in patients with chronic kidney diseases (CKDs). DESIGN, SETTING, PARTICIPANTS AND INTERVENTIONS: The study was performed at the ward of the Nephrology Department, Changhai Hospital, Second Military Medical University from August 2004 to October 2010. Thirty patients with CKDs at stage 2 to 4 and impaired renal function were recruited and randomly assigned to a treatment group or a control group, which consisted of 15 patients in each. Based on conventional therapy with the same oral medicines in the control group, patients in the treatment group were treated with salvianolate combined with alprostadil and reduced glutathione liquid intravenously for 7 to 10 d. Patients in the control group did not receive this combination therapy. The therapy was repeated monthly in patients in the treatment group. The follow-up time was an average of four years. MAIN OUTCOME MEASURES: Assessment of renal function, count of white blood cells, and test of serum hemoglobin, electrolytes and albumin were performed before and every year after treatment. Study endpoints were the serum creatinine level doubled from baseline or receiving replacement therapy. Number of remaining patients in each group was calculated at the end of every year. RESULTS: White blood cell count, serum albumin and electrocyte levels changed little in two groups after four years (P>0.05). Average serum hemoglobin levels in patients in the treatment group was elevated markedly compared with that in the control group after being treated for two years (P<0.01). The percentage of patients reaching the study termination in the treatment group (40%) decreased significantly compared with that (93%) in the control group (P<0.01). CONCLUSION: The regular integrated traditional Chinese and Western medicine can effectively delay the deterioration of renal function in patients with CKDs over a period of four years.

Proliferation of renal mesangial cells induced by very low density lipoprotein is mediated by p42/44 mitogen activated protein kinase.

BACKGROUND: The plasma concentration of very low density lipoprotein (VLDL) is negatively correlated to renal function in glomerular diseases. Effects of VLDL on renal function have been partially attributed to the proliferation of mesangial cells. This study examined the potential role of the p42/44 mitogen activated protein kinase (MAPK) in mesangial cell proliferation induced by VLDL. METHODS: Mesangial cells were treated with VLDL at different concentrations or for different time. The cell cycle of the mesangial cells was analyzed by XTT assay and flow-cytometry; MAPK activity was also assayed. In some experiments, cells were treated with VLDL together with or without 0.1 µmol/L PD 98059. RESULTS: Ten to 500 µg/ml VLDL stimulated the proliferation of mesangial cells cultured in vitro in a concentration-dependent manner. The effect was associated with an increase in p42/44 MAPK activity. Increased proliferation of mesangial cells by VLDL was significantly attenuated by PD98059, a specific p42/44 MAPK inhibitor. CONCLUSION: These results indicate that the p42/44 MAPK pathway is an important regulator of mesangial cell proliferation and of renal functions.

[Role of cyclin kinase inhibitor p27 in inhibition of emodin on mesangial cell proliferation induced by tumor necrosis factor-alpha].

OBJECTIVE: To investigate the role of p27 in the inhibition of emodin on the mesangial cell (MC) proliferation induced by tumor necrosis factor-alpha(TNF-alpha). METHODS: p27 protein of MC was detected with western blotting analysis. The degree of MC proliferation was estimated through [(3)H] thymidine ([(3)H] TdR) incorporation. Different dosage of emodin (50 mg/L,100 mg/L) was added into MC stimulated by TNF-alpha. RESULTS: TNF-alpha (200 kU/L) decreased p27 level of MC cultured in serum-free DMEM for 24 hours and increased[(3)H] TdR incorporation. Emodin increased p27 level of MC stimulated by TNF-alpha and decreased [(3)H] TdR incorporation. The more the emodin was added, the greater the above-mentioned effect of emodin. CONCLUSION: The increment of p27 level maybe play an important role in the inhibition of emodin on MC proliferation induced by TNF-alpha.