BACKGROUND/AIMS: Steroid therapy is reported to improve the clinical outcome of IgA nephropathy. In addition, recent studies have revealed that deflazacort has fewer side effects than prednisolone. This study examined the effect of steroids and compared the clinical efficacy of deflazacort and prednisolone in patients with IgA nephropathy. METHODS: We retrospectively reviewed 136 patients with biopsy-proven IgA nephropathy who received deflazacort (n=50), prednisolone (n=29), or neither (n=59), and in whom blood pressure was controlled with angiotensin converting enzyme inhibitors or angiotensin receptor blockers. The mean duration of steroid administration was 9.5+/-9.1 months. The initial clinical status and change in the amount of protein in the 24-hour urine were compared among the three groups. RESULTS: The baseline characteristics (age, blood pressure, serum creatinine level, initial protein in the 24-hour urine, and creatinine clearance) did not differ significantly among the groups. The decrement of protein in the 24-hour urine was higher in the deflazacort and prednisolone groups, as compared with the control group (4.4+/-5.4, 4.2+/-1.5, and 2.1+/-3.1 g/day, respectively, p=0.013). The increment in the creatinine clearance was higher in the deflazacort and prednisolone groups, as compared with the control group (11.5+/-16.4, 12.3+/-26.2, and 4.8+/-14.91.3+/-0.9, respectively, p=0.009). There were no significant differences in the above parameters between the deflazacort and prednisolone groups. CONCLUSIONS: Steroid therapy reduces urinary protein excretion in IgA nephropathy, and the clinical efficacy of deflazacort and prednisolone was found to be similar.
Angiotensin Receptor Antagonists ; Angiotensin-Converting Enzyme Inhibitors ; Blood Pressure ; Creatinine ; Glomerulonephritis ; Glomerulonephritis, IGA ; Humans ; Immunoglobulin A ; Prednisolone ; Pregnenediones ; Proteinuria ; Retrospective Studies ; Steroids

PURPOSE:Although fractional excretion of sodium (FENa) has been used to distinguish transient-acute kidney injury (T-AKI) from persistent-AKI (P-AKI), the availability of FENa in the diagnosis of T-AKI is reported low in patients with diuretics use. We compared the diagnostic performance of fractional excretion of urea (FEUrea) with that of FENa in patients with diuretics use. METHODS:One hundred seven AKI patients were classified as having T-AKIor P-AKI according to the clinical context. Each group was again subdivided according to exposure to diuretics. According to the cut off value generated by receiver operating characteristic (ROC) curves, sensitivity and specificity of FENa and FEUrea were compared with each other. RESULTS:The numbers of patients administered with diuretics were 67 out of total 107 AKI patients (63%), 27 out of 52 (52%) of T-AKI patients, and 40 out of total (65) 55 (73%) of P-AKI patients. When the cutoff value of T-AKI was defined as FENa < or =1.5 and FEUrea < or = 30 according to the ROC curves, sensitivity and specificity of FENa were 96% and 100% in non-diuretics group, and 63% and 98% in diuretics group, respectively. Sensitivity and specificity of FEUrea were 92% and 87% in non- diuretics group, and 96% and 83% in diuretics group, respectively. CONCLUSION:FEUrea is as good as FENa at distinguishing T-AKI from P-AKI in patients administered with diuretics.
Acute Kidney Injury ; Diuretics ; Humans ; Kidney ; Renal Insufficiency ; ROC Curve ; Sensitivity and Specificity ; Sodium ; Urea

STUDY DESIGN: Retrospective comparative study. PURPOSE: To study and compare the surgical outcomes of muscular dystrophy (MD) and spinal muscle atrophy (SMA). OVERVIEW OF LITERATURE: There are few reports that have evaluated and compared the surgical outcomes of MD and SMA patients. METHODS: The patients (n = 35) were divided into two groups: a MD group with 24 patients and a SMA group with 11 patients. The average follow-up period was 21 months. All patients were operated for scoliosis correction using posterior instrumentation and fusion. In the immediate postoperative period, all efforts were made to reduce the pulmonary complications using non-invasive positive pressure ventilation and a coughing assist devices. The patients were evaluated by radiograph in terms of the Cobb's angle, pelvic obliquity, T1 translation, thoracic kyphosis and lumbar lordosis. The pulmonary function and self-image satisfaction were also assessed. RESULTS: There was a lower correction rate in the MD group (41.5%) than in the SMA group (48.3%), even though the curves were smaller in the MD group. The correction in the pelvic obliquity was significantly better in the SMA group (p = 0.03). The predicted vital capacity showed a 4% reduction in the MD group 1 year after surgery, while the SMA group showed a 10% reduction. The peak cough flow and end tidal PCO2 did not deteriorate and were well maintained. The average score for the improvement in self-image satisfaction postoperatively was 3.96 and 4.64 for the MD and SMA groups, respectively. The total complication rate was 45.7%; 14.3% of which were respiratory-related. CONCLUSIONS: Surgical intervention for MD and SMA may be performed safely in patients with a very low forced vital capacity (< 30%) through aggressive preoperative and postoperative rehabilitation efforts.
Animals ; Cough ; Follow-Up Studies ; Humans ; Kyphosis ; Lordosis ; Muscular Atrophy ; Muscular Atrophy, Spinal ; Muscular Dystrophies ; Positive-Pressure Respiration ; Postoperative Period ; Retrospective Studies ; Scoliosis ; Vital Capacity