The urine albumin-to-creatinine ratio is a reliable indicator for evaluating complications of chronic kidney disease and progression in IgA nephropathy in China

OBJECTIVE: This study investigated the correlation between the albumin-to-creatinine ratio in the urine and 24-hour urine proteinuria and whether the ratio can predict chronic kidney disease progression even more reliably than 24-hour proteinuria can, particularly in primary IgA nephropathy. METHODS: A total of 182 patients with primary IgA nephropathy were evaluated. Their mean urine albumin-to-creatinine ratio and 24-hour proteinuria were determined during hospitalization. Blood samples were also analyzed. Follow-up data were recorded for 44 patients. A cross-sectional study was then conducted to test the correlation between these parameters and their associations with chronic kidney disease complications. Subsequently, a canonical correlation analysis was employed to assess the correlation between baseline proteinuria and parameters of the Oxford classification. Finally, a prospective observational study was performed to evaluate the association between proteinuria and clinical outcomes. Our study is registered in the Chinese Clinical Trial Registry, and the registration number is ChiCTR-OCH-14005137. RESULTS: A strong correlation (r=0.81, p<0.001) was found between the ratio and 24-hour proteinuria except in chronic kidney disease stage 5. First-morning urine albumin-to-creatinine ratios of ≥125.15, 154.44 and 760.31 mg/g reliably predicted equivalent 24-hour proteinuria ‘thresholds’ of ≥0.15, 0.3 and 1.0 g/24 h, respectively. In continuous analyses, the albumin-to-creatinine ratio was significantly associated with anemia, acidosis, hypoalbuminemia, hyperphosphatemia, hyperkalemia, hypercholesterolemia and higher serum cystatin C. However, higher 24-hour proteinuria was only associated with hypoalbuminemia and hypercholesterolemia. Higher tubular atrophy and interstitial fibrosis scores were also associated with a greater albumin-to-creatinine ratio, as observed in the canonical correlation analysis. Finally, the albumin-to-creatinine ratio and 24-hour proteinuria were associated with renal outcomes in univariate analyses. CONCLUSION: This study supports the recommendation of using the albumin-to-creatinine ratio, rather than 24-hour proteinuria, to monitor proteinuria and prognosis in primary IgA nephropathy.

Progress on the M-type phospholipase A2 receptor in idiopathic membranous nephropathy / 中华医学杂志(英文版)

<p><b>OBJECTIVE</b>To highlight current knowledge about M-type phospholipase A2 receptor (PLA2R) which is the first human autoantigen discovered in adult idiopathic membranous nephropathy.</p><p><b>DATA SOURCES</b>Relevant articles published in English from 2000 to present were selected from PubMed. Searches were made using the terms "idiopathic membranous nephropathy, M-type PLA2R and podocyte."</p><p><b>STUDY SELECTION</b>Articles studying the role of M-type PLA2R in idiopathic membranous nephropathy were reviewed. Articles focusing on the discovery, detection and clinical observation of anti-PLA2R antibodies were selected.</p><p><b>RESULTS</b>M-type PLA2R is a member of the mannose receptor family of proteins, locating on normal human glomeruli as a transmembrane receptor. The anti-PLA2R in serum samples from MN were primarily IgG4 subclass. Technologies applied to detect anti-PLA2R autoantibody are mainly WB, IIFT, ELISA and so on. Studies from domestic and overseas have identified a strongly relationship between circulating anti-PLA2R levels and disease activity.</p><p><b>CONCLUSION</b>Recent discoveries corresponding to PLA2R facilitate a better understanding on IMN pathogenesis and may provide a new tool to its diagnosis, differential diagnosis, risk evaluation, response monitoring and patient-specific treatment.</p>

Influence of Chinese Herbal Medicine on Effect of Immunosuppressant for the Treatment of Lupus Nephritis Complicated with Femoral Head Necrosis / 广州中医药大学学报

Objective To investigate the influence of Chinese herbal medicine on effect of immunosuppressant for the treatment of lupus nephritis complicated with femoral head necrosis (FHN),and to observe the adverse reaction.Methods Forty-five lupus nephritis patients complicated with FHN were randomized into 2 groups:the control group (N=18)received immunosuppressant regimen without medication of hormone,and the treatment group (N=27)received Chinese herbal medicine based on immunosuppressant regimen.The activity of systemic lupus erythematosus (SLE),and the incidences of lupus nephritis and adverse reaction were monitored during the 3-year follow-up.Results (1)After treatment,the total score of symptoms was decreased in the two groups (P0.05).(3)The urine protein volume and urine red blood cell (RBC)count were decreased in the two groups after treatment (P

Therapeutic Effect of TCM Syndrome Differentiation and Treatment for IgA Nephropathy / 广州中医药大学学报

【Objective】To explore the therapeutic effect of TCM syndrome differentiation and treatment for immunoglobulin A(IgA) nephropathy.【Methods】The selected 123 patients with IgA nephropathy were divided into two groups(in the proportion of 3∶1) by number randomization.Group A(n=86) was given Tripterygium Glycosides tablets and differential treatment according to syndrome patterns,and Group B(n=37) was given routine western medicine including anti-inflammation drugs,drugs for controlling blood pressure and glucocorticoid hormone.The two groups received a 3-month treatment course and received one more course according to individual cases.The total therapeutic effect,effect for TCM syndrome patterns,and toxic and side effects were observed.The changes of TCM syndrome scoring were compared before and after treatment.【Results】In group A,symptoms were completely relieved in 29,markedly relieved in 30,relieved in 15 and un-relieved in 12 patients,the total effective rate being 86.05%,while respectively in 4,5,10 and 18 of patients in group B,the total effective rate being 51.35%.The total effect was better in group A than that in group B(P0.05).The improvement on TCM syndrome scoring in group A was superior to that in group B(P

Multivariate Analysis of TCM Syndromes of IgA Nephropathy / 广州中医药大学学报

【Objective】To explore the relationship of pathological changes,clinical manifestations and results of laboratory examination with TCM syndromes in patients with IgA nephropathy.【Methods】With parameters in Memphis renal biopsy accessing system and principle syndromes and complicated syndromes in differentiation criteria of chronic nephritis as reference,pathological changes and clinical manifestations of IgA nephropathy were classified by principle component analysis and factor analysis.The regression equations of different syndromes were established after a regression analysis of the principle components of pathological changes and clinical manifestations with the standard syndromes.【Results】(1)With the parameters in Memphis renal biopsy accessing system as reference,the principle components(reflecting over 85% information of glomerular changes)of pathological changes in 123 IgA nephropathy patients were glomerulosclerosis,crescent,stroma,immunofluorescence IgA and complement 3(C_3).With principle syndromes and complicated syndromes in differentiation criteria of chronic nephritis as reference,the principle components(reflecting over 90% information of syndrome manifestations)were lassitude and weakness for deficiency syndrome,cold limbs,white tongue and slippery fur and deep-thready pulse for yang-deficiency syndrome,and dry mouth and throat,red tongue and thready pulse for yin-deficiency syndrome.For liver-stagnation syndrome,the principle components were impatience and irritability,bitterness in mouth,frequent sighing and wiry pulse;for bloodstasis syndrome,the principle components was purple tongue with ecchymosis;for phlegm-damp syndrome,the principle components were heaviness of limbs,greasy fur,abdominal distension and impaired appetite;for heat-toxic syndrome,the principle components were sore throat,purulent sore and yellowish tongue with dry fur;for damp-heat syndrome,the principle components were bitterness and stickiness in mouth,and yellowish greasy fur.(2)The regression equations of syndromes of yin deficiency,yang deficiency,yin-yang deficiency,blood stasis,phlegm damp and liver stagnation were obtained.(3)The results of non-conditional Logistic regression analysis showed that yang-deficiency syndrome was correlated with edema,the incidence of yang deficiency in edema patients being 1.6 times of that in patients without edema;yin-deficiency syndrome was positively correlated with gross hematuria,the incidence of yin deficiency in patients with gross hematuria being 1.5 times of that in patients without gross hematuria;pain in waist and back was the common signs in patients with yin deficiency,yang deficiency and yin-yang deficiency.【Conclusion】Parameters of glomerulosclerosis,crescent,stroma,immunofluorescence IgA and C_3 reflect over 85% information of glomerular changes in IgA nephropathy patients;there exists a relationship of TCM syndrome with pathological changes and clinical manifestations;yang-deficiency syndrome is correlated with edema and yin-deficiency syndrome is correlated with gross hematuria.

Kidney Disease Complicated with Steroid-Induced Necrosis of Femoral Head: An Analysis of 62 Cases / 广州中医药大学学报

[Objective] To investigate the onset of steroid-induced necrosis of femoral head. [Methods] A retrospective study was carried out in 162 cases of kidney disease treated with steroid. Among them, 62 cases (Group A) was complicated with steroid-induced femoral head necrosis (FHN) and the others without the complication are in Group B. [Resuits] In 62 cases complicated with steroid-induced FHN, patients in the age of 20-30 accounted 93.5%; female accounted 54.8%; those with high weight index accounted 80.6% and patients complicated with blood-stasis syndrome accounted 90%; 51.6% suffered from lupus glomerulonephritis; 96.8% was given large dose of steroid (over 1 rag' kg~(-1)?d~(-1)) continuously over 2 months; 83.9% was given steroid in a total dosage of over 5000mg within one year; 54.9% has been given dexamethasone and 83.9% medicated intravenously; 67.7% has not given blood-activating stasis-removing herbal drugs (BSHD) combined with or without anticoagulation drugs (ACD). Ninety percent suffered from necrosis of bilateral hip joints and 67.7% from bilateral hip-joint disease; 68.8% suffered from FHN at the stage Ⅲ and Ⅳ. The above indexes differed from those without steroid-induced FHN. [Conclusion] The incidence of steroid -induced FHN in kidney disease is high in the female and in the cases of lupus glomerulonephritis: those who are in obesity, complicated with blood-stasis syndrome, given large-dose steroid (over 1mg?kg~(-1)?d~(-1)) continuously over 2 months or in a short term, or medicated with dexamethasone, have the high risk of steroid -induced FHN; bilateral hip-joint disease is in the majority. The combination of BSHD and ACD can decrease the incidence of steroid -induced FHN in kidney disease.