No abstract available.
Adult ; Anti-Neutrophil Cytoplasmic Antibody-Associated Vasculitis/*complications/diagnosis/drug therapy/immunology ; Antibodies, Antineutrophil Cytoplasmic/*blood ; Biomarkers/blood ; Biopsy ; Drug Therapy, Combination ; Fluorescent Antibody Technique ; Glomerulonephritis, IGA/*complications/diagnosis/drug therapy/immunology ; Humans ; Immunosuppressive Agents/therapeutic use ; Male ; Myeloblastin/*immunology ; Treatment Outcome

BACKGROUND/AIMS: Immunoglobulin A nephropathy (IgAN) is a generally progressive disease, even in patients with favorable prognostic features. In this study, we aimed to investigate the antiproteinuric effect and tolerability of low-dose valsartan (an angiotensin II receptor blocker) therapy in normotensive IgAN patients with minimal proteinuria of less than 0.5 to 1.0 g/day. METHODS: Normotensive IgAN patients, who had persistent proteinuria with a spot urine protein-to-creatinine ratio of 0.3 to 1.0 mg/mg creatinine, were recruited from five hospitals and randomly assigned to either 40 mg of valsartan as the low-dose group or 80 mg of valsartan as the regular-dose group. Clinical and laboratory data were collected at baseline, and at 4, 8, 12, and 24 weeks after valsartan therapy. RESULTS: Forty-three patients (low-dose group, n = 23; regular-dose group, n = 20) were enrolled in the study. Proteinuria decreased significantly not only in the regular-dose group but also in the low-dose group. The change in urine protein-to-creatinine ratio at week 24 was -41.3% +/- 26.1% (p < 0.001) in the regular-dose group and -21.1% +/- 45.1% (p = 0.005) in the low-dose group. In the low-dose group, blood pressure was constant throughout the study period, and there was no symptomatic hypotension. In the regular-dose group, blood pressure decreased at weeks 8 and 12. No significant change in glomerular filtration rate, serum creatinine level, or serum potassium level was observed during the study period. CONCLUSIONS: Our results suggest that low-dose valsartan can significantly reduce proteinuria without causing any intolerability in normotensive IgAN patients with minimal proteinuria.
Adult ; Angiotensin II Type 1 Receptor Blockers/*administration & dosage/adverse effects ; Biomarkers/urine ; Blood Pressure ; Creatinine/urine ; Female ; Glomerulonephritis, IGA/diagnosis/*drug therapy/physiopathology/urine ; Humans ; Male ; Middle Aged ; Prospective Studies ; Proteinuria/diagnosis/*drug therapy/physiopathology/urine ; Republic of Korea ; Time Factors ; Treatment Outcome ; Valsartan/*administration & dosage/adverse effects

Glomerulonephritis occurs as a rare form of renal manifestation in Plasmodium falciparum malaria. Herein, we report a case of falciparum malaria-associated IgA nephropathy for the first time. A 49-yr old male who had been to East Africa was diagnosed with Plasmodium falciparum malaria. Microhematuria and proteinuria along with acute kidney injury developed during the course of the disease. Kidney biopsy showed mesangial proliferation and IgA deposits with tubulointerstitial inflammation. Laboratory tests after recovery from malaria showed disappearance of urinary abnormalities and normalization of kidney function. Our findings suggest that malaria infection might be associated with IgA nephropathy.
Acute Kidney Injury/etiology/pathology ; Antimalarials/therapeutic use ; Creatinine/blood ; Glomerulonephritis, IGA/*diagnosis/*etiology ; Hematuria/etiology ; Humans ; Immunoglobulin A/*metabolism ; Malaria/*complications/drug therapy/*pathology ; Male ; Middle Aged ; Plasmodium falciparum/*isolation & purification ; Proteinuria/etiology ; Quinine/therapeutic use

OBJECTIVETo observe the curative effect of Shenyanning (SYN) on non-nephrotic syndrome IgA nephropathy (IgAN).

METHODSSeventy primary IgAN patients were equally randomized into two groups, the treatment group and the control group, they were orally treated with SYN Decoction (one dose per day) and Losartan (50 mg per day) respectively for 1 year. Efficacy of treatment, Chinese medicine syndrome scores, end-point events occurrence as well as changes of related laboratory indices were observed.

RESULTSThe total effective rate in the treatment group was obviously higher than that in the control group (77.1% vs. 54.3%, P < 0.05). After treatment, the Chinese medicine syndrome scores, urinary protein and urinary red-cell count reduced significantly in the treatment group (P < 0.05 or P < 0.01) and showed significant difference as compared with those in the control group (P < 0.05 or P < 0.01); while the endogenous creatinine clearance was changed insignificantly in both groups. Beside, the occurrence of end-point events in the treatment group was slightly lower than that in the control group, though showed no statistical difference between them.

CONCLUSIONThe curative effect of SYN in treating IgAN was obviously better than that of simple Western medicine.

Adolescent ; Adult ; Diagnosis, Differential ; Drugs, Chinese Herbal ; therapeutic use ; Female ; Glomerulonephritis, IGA ; drug therapy ; Hematuria ; urine ; Humans ; Losartan ; therapeutic use ; Male ; Medicine, Chinese Traditional ; Middle Aged ; Phytotherapy ; Proteinuria ; urine ; Young Adult

To evaluate the effects of cyclosporin A (CyA) on clinical outcome and pathologic changes in children with IgA nephropathy (IgAN), we retrospectively evaluated 14 children (mean age 8.9+/-2.9 yr; eight males, six females) who were treated with CyA and steroids. The starting dose of CyA was 5 mg/kg per day, and the drug level was maintained at 100-200 ng/mL. The mean CyA level was 183.8+/-48.3 ng/mL (range 120.7-276.0 ng/mL) and the mean duration of CyA therapy was 10.9+/-1.9 months (range 8-12 months). After CyA therapy the mean 24 hr urinary protein excretion declined from 107.1+/-35.1 mg/m2/hr to 7.4+/-2.4 mg/m2/hr (P<0.001) and serum albumin increased from 3.3+/-0.6 g/dL to 4.3+/-0.3 g/dL (P<0.001). At a follow-up biopsy the histological grade of IgAN was improved in seven (50%) of the 14 patients, remained the same in three (21%), and was aggravated in four (29%). Serum creatinine, creatinine clearance, and blood pressure did not differ before and after CyA therapy. Two patients (14%) showed CyA-induced nephrotoxicity at the second biopsy. Our findings indicate that CyA therapy may be effective in reducing proteinuria and regressing renal pathology in a subset of children with IgAN.
Angiotensin-Converting Enzyme Inhibitors/*administration & dosage ; Child ; Cyclosporine/*administration & dosage ; Drug Combinations ; Female ; Glomerulonephritis, IGA/*diagnosis/*drug therapy ; Humans ; Immunosuppressive Agents/administration & dosage ; Male ; Steroids/*administration & dosage ; Treatment Outcome

Urological complications are not uncommon in Crohn's disease (CD). The most common manifestations are renal stones, enterovesical fistulas, and ureteral obstruction, but renal parenchymal disease has rarely been reported. IgA nephropathy, the most common form of primary glomerulonephritis, is usually isolated, but can be sometimes associated with chronic extrarenal disorders such as inflammatory bowel disease. We describe a case of 36 year-old man with CD associated with IgA nephropathy. He was diagnosed as CD 6 years ago and at that time, isolated proteinuria was observed. He presented recurrent proteinuria and elevation of creatinine level while he had been managed well with mesalamine and azathioprine. The renal biopsy was performed and IgA nephropathy (type IV) was diagnosed. Strict blood pressure control with angiotensin converting enzyme inhibitor and calcium channel blocker resulted in clinical improvement and normalization of serum creatinine level.
Adult ; Angiotensin-Converting Enzyme Inhibitors/therapeutic use ; Anti-Inflammatory Agents, Non-Steroidal/therapeutic use ; Antimetabolites/therapeutic use ; Azathioprine/therapeutic use ; Blood Pressure ; Calcium Channel Blockers/therapeutic use ; Colonoscopy ; Crohn Disease/*diagnosis/drug therapy/etiology ; Glomerulonephritis, IGA/complications/*diagnosis/pathology ; Humans ; Male ; Mesalamine/therapeutic use ; Proteinuria/diagnosis/etiology

OBJECTIVETo evaluate the effect and safety of Chinese medicine Compound Shenhua Tablet (SHT) on IgA nephropathy patients of TCM Qi-yin deficiency syndrome type, by using angiotensin-converting enzyme inhibitors (ACEI) fosinopril as the positive control.

METHODSAdopting prospective, multicentered, double-blinded, double-dummy, randomized, controlled trial design, 131 patients with IgA nephropathy of Qi-yin deficiency syndrome type were assigned to two groups, the 65 patients in the treated group (SHG) and the 66 in the control group treated with SHT and fosinopril respectively for 12 weeks. The indexes of efficacy, including TCM syndrome scores, urinary protein, serum creatinine, urea nitrogen and endogenous creatinine clearance rate, as well as the indexes of safety, including liver function and occurrence of adverse events were observed.

RESULTSThere was no significant statistical difference between the two groups in aspects of baseline demographic characteristics and clinical figures, including gross hematuria, hypertension, incidence of renal insufficiency, total course of disease, urinary protein, TCM syndrome score, renal pathological Katafuchi score, glomerular score, tubular-interstitial score, vascular score and Lee grading. Afte 12 weeks of treatment, the content of 24-h urinary protein significantly decreased by 0.26 +/- 0.95 g/24 h and 0.26 + 0.92 g/24 h respectively in the two groups, showing significant difference in comparing with baseline, but insignificant difference between the two groups (P > 0.05); the scores of TCM dominant syndromes in them decreased by 2.52 +/- 2.34 scores and 1.74 +/- 2.12 scores respectively with significant difference as compared with baseline (P < 0.01), and in comparison between groups (P < 0.05). No significant change in levels of serum creatinine, urea nitrogen, endogenous creatinine clearance rate in both groups was found (P > 0.05). Scores of TCM accompanied syndromes in the two groups was significantly decreased (P < 0.01), but the difference between them was insignificant (P > 0.05). No severe adverse event occurred during treatment, and the occurrence in the two groups was similar.

CONCLUSIONSHT, just like the positive control medicine fosinopril, can effectively decrease the proteinuria and improve clinical syndrome of IgA nephropathy patients of Qi-yin deficiency syndrome type, and shows no serious adverse reaction.

Adolescent ; Adult ; Aged ; Diagnosis, Differential ; Double-Blind Method ; Drugs, Chinese Herbal ; therapeutic use ; Female ; Glomerulonephritis, IGA ; drug therapy ; pathology ; Humans ; Male ; Medicine, Chinese Traditional ; Middle Aged ; Phytotherapy ; Prospective Studies ; Qi ; Syndrome ; Yin Deficiency ; drug therapy ; pathology

Adrenergic alpha-Antagonists ; therapeutic use ; Cholinesterase Inhibitors ; therapeutic use ; Diagnosis, Differential ; Drug Therapy, Combination ; Drugs, Chinese Herbal ; therapeutic use ; Glomerulonephritis, IGA ; diagnosis ; drug therapy ; Humans ; Medicine, Chinese Traditional ; Phytotherapy

Diagnosis, Differential ; Drugs, Chinese Herbal ; therapeutic use ; Glomerulonephritis, IGA ; complications ; diagnosis ; drug therapy ; Humans ; Kidney Failure, Chronic ; drug therapy ; etiology ; Medicine, Chinese Traditional ; Phytotherapy

Diagnosis, Differential ; Drug Therapy, Combination ; Drugs, Chinese Herbal ; therapeutic use ; Glomerulonephritis, IGA ; diagnosis ; drug therapy ; Humans ; Medicine, Chinese Traditional ; Phytotherapy ; Treatment Outcome