Comparative efficacy of three regimens (cyclosporine, tacrolimus, and cyclophosphamide) combined with steroids for the treatment of idiopathic membranous nephropathy.

INTRODUCTION AND OBJECTIVES: To investigate the efficacy of combined immunosuppressive regimens of cyclosporine (CsA), tacrolimus (TAC), or cyclophosphamide (CTX) combined with steroids in the treatment of idiopathic membranous nephropathy (IMN). MATERIALS AND METHODS: A total of 150 biopsy-proven IMN patients were divided into three groups: CTX, TAC, and CsA groups (50 cases each). Patients received a selected regimen for 48 weeks. The efficacy (remission rate, 24h urinary protein, and serum albumin and creatinine) and safety (adverse events) profiles of administered regimens were evaluated at 12, 24 and 48 weeks. RESULTS: At 12 weeks, the response rates for CsA, TAC, and CTX groups were 14%, 50%, and 22%, respectively. This increased to 74%, 84%, and 82%, respectively at 48 weeks. During follow-up, 24h urinary protein significantly reduced from baseline in all regimens (P<0.05), while serum albumin increased in TAC and CTX groups after 12 weeks (P<0.05), and CsA group at 48 weeks (P<0.05). No significant changes in serum creatinine levels were noted in all three regimens (P>0.05). Safety was comparable in all groups, with lower respiratory tract infection being the most frequent adverse event. CONCLUSIONS: The combined regimens (i.e., TAC, CsA, and CTX) are effective in the treatment of patients with IMN at 48 weeks, while TAC and CTX might be more beneficial in terms of shortened time to remission and increased complete response rate.

[Effect of water conservancy schistosomiasis control projects combined with molluscicide to control Oncomelania hupensis snails in rivers connecting with Yangtze River in Pukou District, Nanjing City].

OBJECTIVE: To evaluate the effect of the water conservancy schistosomiasis control projects combined with molluscicide to control Oncomelania hupensis snails in the rivers connecting with the Yangtze River. METHODS: The water conservancy schistosomiasis control projects of Zhujiashan River, Qili River and Gaowang River were chosen as the study objects in Pukou District, Nanjing City. The data review method and field investigation were used to evaluate the effect of the water conservancy schistosomiasis control projects combined with molluscicide to control O. hupensis snails. RESULTS: After the projects of the water level control and concrete slope protection and mollusciciding were implemented, the snails in the project river sections were completely eliminated. The snail diffusion did not happen in the inland irrigation area too. In the outside of the river beach, though the snails still existed, the snail densities plunged below 1.0 snail per 1.0 m2. CONCLUSIONS: The comprehensive measures of the combination of water level control, concrete slope protection and mollusciciding can effectively control and eliminate the snails, and prevent the snails from spreading.