Membranous nephropathy caused by dimercaptosuccinic acid in a patient with Wilson's disease: a case report and literature review.

BACKGROUND: Dimercaptosuccinic acid (DMSA) therapy is a kind of chelation therapy for patients with Wilson 's disease (WD). While there have been reports of side effects associated with DMSA, the development of membranous nephropathy as a result of this therapy is uncommon. CASE PRESENTATION: We present a case of a 19-year-old male patient with Wilson's disease who experienced proteinuria while receiving long-term DMSA treatment. Further evaluation revealed abnormally low levels of serum ceruloplasmin and serum albumin, as well as a 24-hour urinary protein excretion of 4599.98 mg/24 h. A renal biopsy confirmed the presence of membranous nephropathy. After ruling out other potential causes, we determined that the patient's membranous nephropathy was likely caused by DMSA. Following treatment with glucocorticoids, there was a significant reduction in proteinuria. CONCLUSION: This case highlights the possibility of DMSA-induced membranous nephropathy and the importance of considering this diagnosis in patients receiving DMSA treatment. Given the widespread use of DMSA in the treatment of Wilson's disease, further research is needed to fully understand the potential role of this drug in the development of membranous nephropathy.

Clinical Efficacy and Safety of Jinshuibao Combined With ACEI/ARB in the Treatment of Diabetic Kidney Disease: A Meta-Analysis of Randomized Controlled Trials.

OBJECTIVE: The present study aims to compare the relative efficacy and safety of jinshuibao (JSB) combined with angiotensinconverting enzyme inhibitors/angiotensin receptor blockers (ACEIs/ARBs) in the treatment of diabetic kidney disease. METHODS: We searched EMBASE, MEDLINE, PubMed, China National Knowledge Internet, the Chinese Biomedical Database, and Wanfang database for articles from the building of the database to September 2018. RESULTS: Fifty-one randomized controlled trials with 3,955 participants were included. The meta-analysis indicated that compared with the controls, JSB combined with ACEI/ARB group could remarkably improve the overall response rate (odds ratio 4.91; 95% confidence interval [CI] 3.32-7.25) and reduce 24 h proteinuria (mean difference [MD] -0.16; 95% CI -0.19 to -0.13), urine albumin excretion ratio (MD -28.20; 95% CI -36.30 to -20.11), serum creatinine (MD -13.84; 95% CI -18.01 to -9.68), blood urea nitrogen (MD -1.00; 95% CI -1.36 to -0.63), systolic blood pressure (MD -4.57; 95% CI -6.78 to -2.37), diastolic blood pressure (MD -3.96; 95% CI -5.73 to -2.19), fasting blood glucose (MD -0.85; 95% CI -1.45 to -0.24), hemoglobin A1c (MD -0.52; 95% CI -0.83 to -0.21), serum total cholesterol (MD -0.53; 95% CI -0.86 to -0.20), and triglyceride (MD -0.53; 95% CI -0.55 to -0.51). CONCLUSIONS: JSB combined with ACEI/ARB in the treatment of diabetic kidney disease is superior to the single application of ACEI/ARB.

Clinical efficacy and safety of Tripterygium wilfordii Hook in the treatment of diabetic kidney disease stage IV: A meta-analysis of randomized controlled trials.

BACKGROUND: The present study aims to evaluate the clinical efficacy and safety of Tripterygium wilfordii Hook (TwH) combined with angiotensin receptor blockers/ACE inhibitors (ARB/ACEI) in the treatment of diabetic kidney disease (DKD) stage IV. METHODS: We searched China National Knowledge Internet (CNKI), the Chinese Biomedical Database, Embase and PubMed for articles about TwH combined with ARB/ACEI in treating DKD stage IV and set the study inclusion and elimination standards. RESULTS: A total of 22 randomized controlled trials (RCTs) with 1414 participants were collected for detailed evaluation. The meta-analysis results suggested that compared with the controls, the combined group showed significant effects in reducing 24-h urinary protein [mean difference (MD) = -0.87, 95% confidence interval (CI) = (-1.03, -0.71)], raising serum albumin [MD = 4.14, 95% CI (3.43, 4.85)] and the total efficiency [odds ratio (OR) = 4.84, 95% CI (3.33, 7.03)], with no statistical difference in serum creatinine between both groups [MD = -3.02, 95% CI (-6.40, 0.37), P > .05]. However, the risk of adverse reactions increased by 8% [Risk Difference (RD) = 0.08, 95% CI (0.05, 0.11)] in the combination. CONCLUSIONS: TwH combined with ARB/ACEI in the treatment of DKD stage IV is superior to the monotherapy of ARB/ACEI.

Antioxidant and antithrombotic therapies for diabetic kidney disease.

With an increasing incidence, diabetic kidney disease (DKD) has been the leading cause of chronic kidney disease and end-stage renal disease, and conventional therapies did not change this situation. This study intended to review and analyze the antioxidant and antithrombotic treatments of DKD for seeking novel therapeutic strategies. Relevant articles involved with antioxidant and antithrombotic treatments in DKD were retrieved and analyzed via systematic assessment. Meta-analysis showed that pancreatic kallikrein definitely reduced glycated hemoglobin in DKD patients (mean difference, 0.36%; 95% confidence interval, 0.08% to 0.63%; P = .01). Apart from the classic agents such as aspirin, novel drugs such as pancreatic kallikrein, sulodexide, and especially the traditional Chinese medicine including Tripterygium wilfordii and lumbrukinase, exert beneficial effects in DKD patients. Antioxidant and antithrombotic treatments are beneficial for DKD patients and represent promising therapeutic strategies in the future.

Hot bath for the treatment of chronic renal failure.

BACKGROUND: Dialysis and its complications were debated recently. There was lack of an adjuvant renal replacement method to reduce the complications of patients with chronic renal failure and dialysis itself. MATERIALS AND METHODS: In this article, we reviewed the role of thermal sweating in treating of the patients with chronic renal failure, and the role of traditional Chinese medicine in the therapy of chronic kidney diseases. RESULTS: Thermal sweating can reduce interdialytic weight gain and improve the patients' blood pressure; Chinese herbal medicine can promote the excretion of uremic toxicities and relieve the skin disorders of these patients. CONCLUSIONS: Traditional Chinese medicine-mediated hot bath could be one of the adjuvant renal replacement methods.

Tripterygium wilfordii Hook F treatment for idiopathic refractory nephrotic syndrome in adults: a meta-analysis.

Tripterygium wilfordii Hook F (TwHF) is a Chinese herbal medicine with immunosuppressive effects and an established history of use in the treatment of inflammatory and autoimmune diseases. We have carried out a meta-analysis of randomized controlled trials (RCTs) and quasi-RCTs which assessed the effectiveness of TwHF in the treatment for idiopathic refractory nephrotic syndrome (IRNS). After reading the full text, only three RCTs or quasi-RCTs meeting our inclusion criteria were selected. Our meta-analysis indicated that TwHF has beneficial effects on the remission of IRNS. There was no significant publication bias in the meta-analysis studies. However, studies with a larger sample size and including patients with both a mild and severe histopathological change involvement separately are needed to assess the effects of TwHF in IRNS patients before exact conclusions can be drawn.