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

ABSTRACT

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 .