ObjectiveTo investigate the distribution and antibiotic resistance of pathogens isolated from children with primary nephrotic syndrome (PNS) complicated with urinary tract infection (UTI), so as to provide references for reasonable use of anti-infective agents in clinical practice. MethodsA total of 218 eligible patients who hospitalized in our department between January 2009 and December 2012 were included, and the data of distribution and antibiotic resistance of pathogens were analyzed retrospectively. ResultsIn this cohort, asymptomatic UTI in children with PNS accounted for 75.7% (165/218). And a total of 249 pathogenic strains were isolated and cultivated. The main pathogens of those subjects were G- bacilli, accounting for 64.3% (160/249), and 63.8% (102/160) of G- bacilli was Escherichia coli (E.coli); G+ cocci accounted for 31.7% (79/249), and 59.5% (47/79) of them was Enterococci faecalis; and fungi accounted for only 4.0%. Drug-susceptibility testing suggested that E.coli had a high resistance rate to hydroxyl ampicillin, cefazolin and ceftriaxone (>50%), but had lower resistance rate to cefoperazone/sulbactam and imipenem (<10%). Enterococci faecalis had a high resistance rate to rifampicin (74.6%), but had low resistance to vancomycin and linezolid (<10%). ConclusionAsymptomatic UTI is common in children with PNS. E.coli is the major pathogen and the proportion of enterococcus infection is also not low, and these pathogens have a high antibiotic resistance and most of them are multi-resistant.
Objective To report an evidence-based treatment of Mycophenolate Mofetil for idiopathic membranous nephropathy (IMN) with nephrotic syndrome (NS). Methods We searched The Cochrane Library (Issue 3, 2005), MEDLINE (1978 to 2006) and CNKI (1978 to 2006), and critically appraised the available evidence. Results The available Level C (low quality) evidence showed that Mycophenolate Mofetil was effective for the remission of proteinuria, and effective in patients who were resistant to steroid or cytotoxic agents. However, there was no evidence on its long-term effect on renal survival. Given the current evidence, together with our clinical experience and the patient’s preference, Mycophenolate Mofetil and glucocorticoid were administered to the patient. After 3 months of treatment, proteinuria was relieved. The patient is still can followed up. Conclusions We only find Level C evidence to support the short-term efficacy of Mycophenolate Mofetil on the remission of proteinuria. Further studies on its long-term effects on renal survival, and a health economics evaluation are needed.
Objective To provide evidence for clinical practice by assessing the effectiveness and safety of Ligustrazine for primary nephrotic syndrome. Methods We searched MEDLINE (1966.1-2002.12), EMBASE (1975-2002.12), CBM (1979.1-2002.12), Chinese Evidence-Based Medicine/Cochrane Centre Database (CEBM/CCD, Issue 4, 2002) , Cochrane Library, and SCI (1985-2002.12) and handsearched 15 kinds of journals (including Journal of Nephrology et al) (1980-2003.2) for the randomized controlled trials (RCTs).Jadad score was used to assess the quality of RCTs. The outcomes of short term and long term effectiveness, and adverse effect of the treatment were analyzed by RevMan 4.1. Results Thirteen RCTs involving 675 patients met inclusion criteria. Jadad scores of each trial was 1 point. Meta-analysis of 4 studies showed that Ligustrazine had significant better short term effect [OR 4.24, 95% confidence interval (CI) 1.76 to 10.19], lowered 24 h urine protein (OR -0.36, 95% CI -0.71 to -0.02), improved renal function [ creatinine level in children group: (OR -3.34, 95% CI -5.25 to -1.43), creatinine level in adult group: (OR -48.29, 95% CI -68.24 to -28.35)], and increased serum albumin level (OR 3.61, 95% CI 2.61 to 4.61). Whether Ligustrazine had long term side effect was not confirmed. No adequate evidence showed that Ligustrazine could reduce the relapse rate of primary nephrotic syndrome. Conclusions Meta-analysis of low quality RCTs suggest that Ligustrazine does work in primary nephritic syndrome in short term observation. No adequate evidence shows that Ligustrazine has severe side effect or can reduce the relapse rate of primary nephrotic syndrome. We can’t draw a conclusion that Ligustrazine is safe in primary nephrotic syndrome treatment.A rigorously designed, randomized, double blind, placebo controlled trial are required.
目的探讨肝肾联合移植的手术技术及临床治疗经验。方法对1例原发性弥漫性肝癌、肝硬变合并肾病综合征、慢性肾功能衰竭患者施行一期肝肾联合移植术，肝移植采用改良背驮式肝移植技术，肾移植采用常规方法。术前、术后行全身辅助性化疗。结果移植肝肾发挥功能，无手术并发症发生，术后3个月无肿瘤复发征象及远处转移，AFP下降到25 μg/L以下。结论对常规手术无法切除且无远处转移的肝癌合并肾功能衰竭者行肝肾联合移植，可以取得较好的临床治疗效果。
目的 探讨肾病综合征并发血栓形成的外科治疗特点。方法 从笔者所在单位收治的肾病综合征并发血栓形成的患者中选取4例血栓形成部位罕见、治疗难度大的病例，对其临床资料进行分析。结果 1例在下肢深静脉血栓形成基础上发生下腔静脉血栓形成；1例腹主动脉急性血栓形成伴下肢动脉栓塞导致下肢坏疽行高位截肢；1例股动脉支架内反复血栓形成导致下肢坏疽行高位截肢；1例人工血管及下肢动脉支架内短时间内血栓形成，经干细胞移植后下肢缺血得到缓解。结论 在血栓形成的诊治过程中提高对肾病综合征的认识，针对肾病综合征患者高凝状态在围手术期进行预防性抗凝治疗，以及充分认识肾病综合征并发血栓形成抗凝治疗的特殊性，可能会降低肾病综合征患者血栓形成的发生率，提高肾病综合征并发血栓形成的外科治疗水平。
ObjectiveTo compare the cost-effectiveness of warfarin and enoxaparin overlapping treatment for the prevention of venous thromboembolism (VTE) or pulmonary embolism (PE) in patients with nephrotic syndrome (NS). MethodsA decision tree model was constructed. The efficacy data applied in our decision tree were from clinical data, and the cost data was based on the hospitalization cost of 103 patients with nephrotic syndrome in Guangdong Provincial People's Hospital from 2013 to 2014, State Development and Reform Commission pricing and literature report. The one-way sensitivity analyses was conducted to analyze the stability of test. ResultsIn base case, the cost and cost-effective ratio of warfarin and enoxaparin overlapped treatment for 3 days were 10305.49 yuan and 31607.15, respectively. While those overlapped treatment for 4 days were 8849.36 yuan and 20896.46, overlapped treatment for 5 days and above were 9494.29 yuan and 21659.95, respectively. The incremental cost-effectiveness ratio of 4 days versus 5 days and above was 5600.96. The cost-effective ratio of 4 days was lower but the incremental cost-effectiveness ratio of it was higher. The sensitivity analysis showed the test result was stable. ConclusionCost-effectiveness analysis shows that warfarin and enoxaparin overlapping treatment for 4 days in patients with nephrotic syndrome has cost-effective advantage. Due to the limited sample size of our study, the above conclusion should be proved by more large-scale high-quality clinical studies.