Child ; Glomerulonephritis ; classification ; diagnosis ; therapy ; Humans

Humans ; Child ; Antibodies, Antineutrophil Cytoplasmic ; Glomerulonephritis/therapy*

Glomerulonephritis, IGA ; diagnosis ; therapy ; Humans ; Integrative Medicine ; Risk Assessment

Child ; Early Diagnosis ; Evidence-Based Medicine ; Glomerulonephritis ; diagnosis ; therapy ; Glomerulonephritis, Membranous ; diagnosis ; therapy ; Humans ; Kidney Diseases ; diagnosis ; therapy ; Kidney Glomerulus ; pathology ; Nephrosis, Lipoid ; diagnosis ; therapy ; Renal Replacement Therapy

The effect of captopril on proteinuria was evaluated in twenty patients with various glomerular diseases excreting heavy proteinuria (> 3.0 g/day). Captopril in a daily dose of 37.5 mg was administered orally three times a day to all patients and they were followed for eight weeks. Twenty-four hour urinary excretion of protein, creatinine, sodium, selective protein index (SPI), and blood chemistry including serum electrolytes were measured every two weeks. Twenty-four hour urinary protein excretion per gram creatinine started to fall within two weeks of captopril administration and became nearly stable after four weeks of therapy (p< 0.05). Mean 24-hour urinary protein excretion decreased significantly from a pretreatment value of 9.0 +/- 6.0 gm/gm of cr. to 4.4 +/- 3.5 gm/gm of cr. after eight weeks of captopril treatment. The serum albumin level increased progressively at six and eight weeks after the captopril treatment period and was significantly higher than the pretreatment value (p< 0.05). The decrease in proteinuria did not coincide with a fall in blood pressure or any changes in creatinine clearance. We conclude that captopril does have a significant antiproteinuric effect in patients excreting heavy proteinuria with various glomerular diseases. However, the long term therapeutic efficacy and any renal protective effect of this drug remain to be proven.
Adult ; Aged ; Blood Pressure/drug effects ; Captopril/*therapeutic use ; Female ; Glomerulonephritis/*drug therapy ; Glomerulonephritis, IGA/*drug therapy ; Glomerulonephritis, Membranous/*drug therapy ; Human ; Male ; Middle Age ; Proteinuria/*drug therapy ; Sodium/urine ; Support, Non-U.S. Gov't

OBJECTIVETo observe the differences of curative effect of glomerular pathological proteinuria treated with combined therapy of acupuncture and medicine or simple medicine.

METHODSTwo hundred and forty cases of glomerular pathological proteinuria were divided into a combined therapy of acupuncture and medicine group (combined therapy group), a medicine group I and a medicine group II, 80 cases in each group. In combined therapy group, Pishu (BL 20) and Zhishi (BL 52) were punctured by heat-producing needling; Terazosin Hydrochloride, Bisoprolol Fumarate tablets or compound Reserpinum Triamterene tablet were applied with oral administration when accompanied by high blood pressure, to control the blood pressure within 130/80 mmHg. In medicine group I , Renin-Angiotensin-Aldosterone system (RAAS) interruption method was applied to control blood pressure; Benazepril Hydrochloride and Telmisartan were applied with oral administration to keep blood pressure in satisfying level, below 125-130/75-80 mmHg. In medicine group II, placebo was orally taken, and the medicine therapy which was same as that in combined therapy group was applied when accompanied by high blood pressure. Quality low protein and low salt and fat diet were applied in all groups. The Chinese medicine syndrome score, laboratory indices and curative effect were observed in all groups before and after treatment.

RESULTSThe total effective rate was 86.3% (69/80), 61.3% (49/80) and 17.5% (14/80) respectively in combined therapy group, medicine group I and medicine group II, indicating that the curative effect in combined therapy group was superior to that in other groups (P < 0.01, P < 0.05), and it in medicine group I was superior to that in medicine group II (P < 0.01). The Chinese medicine syndrome score was markedly reduced in combined therapy group (P < 0.01), and there was no obvious change in other groups (both P > 0.05). Urinary albumin (UMA) and urinary protein in 24 hours were notably reduced in combined therapy group and medicine group I (all P < 0.01), and it was more obviously in combined therapy group than that in other groups (P < 0.01, P < 0.05). The blood pressure was markedly reduced in all groups (all P < 0.05) after treatment, and there was no significant change in indices of liver and kidney functions (all P > 0.05).

CONCLUSIONThe curative effect of heat-producing needling method is good for treating glomerular pathological proteinuria, better than that of RAAS interruption method.

Acupuncture Therapy ; Adult ; Aged ; Female ; Glomerulonephritis ; pathology ; therapy ; Humans ; Male ; Middle Aged ; Proteinuria ; pathology ; therapy ; Treatment Outcome

Glomerulonephritis, Membranous ; drug therapy ; Humans ; Male ; Middle Aged ; Rituximab ; therapeutic use

OBJECTIVETo analysis the clinical and pathological characteristics of children with dense deposit disease (DDD).

METHODS12 Children diagnosed as DDD by electron microscope were enrolled in this study. The clinical and pathological data were analyzed.

RESULTSOf the 12 cases, 7 were males and 5 females, mean age 9.1 +/- 3.9 (5-13) years at onset, the duration from onset to renal biopsy was 1 month to 5 years and the follow-up period was 1-9 years. All cases had heavy proteinuria >50 mg/(kg x d), and persistent microscopic hematuria with recurrent gross hematuria during the course. Seven cases had hypertension (> or = 140/100 mm Hg, 1 mm Hg =0. 133 kPa), 5 cases had transient or recurrent abnormal renal function, and mild to severe anemia were observed in 8 cases respectively. All the cases had lower serum C3 (0.15-0.55 g/L). Clinically, 10 cases were diagnosed as nephritic syndrome (one case had partial lipodystrophy at the same time), and 2 cases were diagnosed as acute nephritic syndrome. Immunofluorescence study showed intense deposition of C3 along GBM, TBM and the wall of Bowman's capsule in a ribbon-like pattern and in the mesangial regions as coarse granules in all the cases. Under light microscopy, 9 cases showed the feature of membrane proliferative glomerulonephritis (MPGN), 1 case with focal segmental glomerulosclerosis (FSGS), 1 case with endocapillary proliferative glomerulonephritis (EnPGN) and 1 case with proliferative sclerosis (PSGN). Crescents were seen in 3 cases. Under electron microscopy, ribbon-like or linear electron-dense intramembranous deposits were identified in the lamina dense of GBM, and often along TBM and the wall of Bowman's capsule. All patients showed steroid resistance. After methylprednisone treatment, some patients showed transient remission. During the follow- up stage of 1-9 years, 3 cases showed normal urinalysis, 5 cases showed partial remission, 2 cases progressed to end stage renal disease (ESRD) and 2 cases were lost.

CONCLUSIONDDD is an in dependently rare disease with pathological-clinical varieties. Children with DDD presented with persistently lower C3, heavy proteinuria, recurrent gross hematuria and anemia. The characteristic immunopathologic finding is intense deposition of C3 along the GBM. Under electron microscopy, ribbon-like or linear electron-dense deposits in the lamina dense of the GBM, TBM and the wall of Bowman's capsule. Electron microscopic examination to demonstrate the intramembranous dense deposits is definitive diagnosis, regardless of the finding of light microscopy. All of them showed steroid resistant. Patients with steroid and CTX treatment showed some clinical improvement of their urinalysis.

Adolescent ; Child ; Child, Preschool ; Female ; Glomerular Basement Membrane ; pathology ; Glomerulonephritis, Membranoproliferative ; diagnosis ; pathology ; therapy ; Humans ; Male

Disease Progression ; Glomerulonephritis, IGA ; surgery ; therapy ; Humans ; Steroids ; therapeutic use ; Tonsillectomy ; Vitamin E ; therapeutic use

C1q nephropathy is a rare type of glomerulonephritis manifested as the deposition of C1q in the glomerular mesangium during immunofluorescent staining. Systemic lupus erythematosus and type I membranoproliferative glomerulonephropathy need to be excluded in the diagnosis of C1q nephropathy. C1q nephropathy has various manifestations under a light microscope, mainly including minimal change disease, focal segmental glomerulosclerosis, and proliferative glomerulonephritis. This disease is mainly manifested as persistent proteinuria or nephrotic syndrome and occurs more frequently in boys. Currently, glucocorticoids are mainly used for the treatment of this disease. Patients with C1q nephropathy show a good response to immunosuppressant treatment, but have a high rate of glucocorticoid resistance. Therefore, in this case, methylprednisolone pulse therapy or a combination with immunosuppressant treatment helps to achieve a good prognosis.
Complement C1q ; metabolism ; Diagnosis, Differential ; Glomerulonephritis ; diagnosis ; drug therapy ; etiology ; Glucocorticoids ; therapeutic use ; Humans ; Prognosis