Objective To explore the clinical efficacy and safety of leflunomide combined with prednisone in the treatment of immunoglobulin A nephropathy.Methods 80 patients with IgA nephropathy were chosen and randomly divided into two groups,40 cases in each group.The control group was orally given prednisone(initial dose 1 mg · kg-1 · d-1),after 2 months of treatment 5mg/2 weeks reduction,and 10mg/d as maintenance therapy,while the observation group was treated with 20mg/d leflunomide treatment based on the treatment of control group.All the two groups had 3 months as a course of treatment.Before treatment and after treatment,the 24h urinary protein,serum albumin,serum creatinine,glomerular filtration rate,cholesterol,triglycerides,cystatin C levels and urinary vascular cell adhesion molecule-1 after treatment (urinary VCAM-1) and interleukin-18 (IL-8) in the two groups were recorded and compared,as well as the clinical efficacy and adverse reactions.Results The total effective rate in the observation group was 92.5％,which was significantly higher than 75.0％ in the control group (x2 =4.501,P ＜ 0.05).After treatment,the serum creatinine,serum albumin,cholesterol,triglycerides,cystatin C,24h urine protein,glomerular filtration rate and urinary VCAM-1,IL-8 in the two groups were all significantly improved (t ≥ 1.945,all P ＜ 0.05).After treatment,the cholesterol and triglycerides in the two groups had no significant differences (t =0.322,1.307,all P ＞ 0.05).After treatment,in the observation group,the serum creatinine,cystatin C,24h urinary protein excretion,VCAM-1 and IL-8 in urine were significantly lower than those in the control group,while serum albumin and glomerular filtration rate were significantly higher (t ≥2.632,all P ＜ 0.05).In the observation group,the total effective rate of Ⅳ,Ⅴ grade by Lee classification were significantly higher (x2 =4.269,4.600,all P ＜ 0.05).And in the two groups,the total effective rate of Ⅰ,Ⅱ grade by Lee classification had no statistically significant differences(x2 =0.000,0.000,all P ＞0.05).In the observation group,the incidence rate of adverse reaction was 10.0％,that in the control group was 8.6％,there was no statistically significant difference between the two groups (x2 =0.157,P ＞ 0.05).Conclusion Leflunomide combined with prednisone in the treatment of IgA nephropathy has better clinical efficacy and higher safety,its mechanism may be associated with decreased urinary VCAM-1 and serum IL-18 levels.

Objective To investigate the effect of cinacalcet combined with low －dose calcitriol in the treatment of patients with secondary hyperparathyroidism of end －stage renal disease.Methods A prospective analysis was conducted in 129 patients with end－stage renal disease and secondary hyperparathyroidism from April 2015 to August 2017 in the Department of Nephrology of Integrative Medicine Hospital of Wenzhou City,Zhejiang Province.The patients were randomly divided into 3 groups:group A received cinacalcet,group B received calcitriol, group C received cinacalcet and low－dose calcitriol for 3 months,respectively.Before and after treatment,the levels of serum phosphorus and serum calcium in the three groups were measured.The levels of parathyroid hormone and the parathyroid hormone clearance rate were measured to find out the therapeutic effect.Results The levels of serum calcium,phosphorus and total parathyroid hormone in group A were significantly lower than those before treatment(t＝3.269,2.263,4.233,all P＜0.05).PTH was significantly decreased,blood calcium and phosphorus significantly in-creased compared with those before treatment,the differences were statistically significant(t＝2.827,2.386,3.342, all P＜0.05).The phosphorus,total parathyroid hormone levels of group C were significantly decreased(t＝3.085, 5.142,all P＜0.05),and no significant change in serum calcium level(t＝0.258,P＞0.05).The total parathyroid hormone level:group B＞group A ＞group C,the whole parathyroid hormone clearance rate:group C ＞group A ＞group B,the differences were statistically significant(t ＝3.642,3.263,all P＜0.05).After treatment,the serum calcium level among the three groups had statistically significant difference,group B＞group C＞group A,the serum phosphorus level among the three groups after treatment had statistically significant difference,group B＞group A ＞group C (t＝3.265,3.332,all P＜0.05).Conclusion The combined use of cinacalcet and low－dose calcitriol in the treatment of secondary hyperparathyroidism in patients with end－stage renal disease can significantly reduce the level of parathyroid hormone and serum phosphorus,and without affecting serum calcium concentration.