Objective To carry out Meta analyses about the published literature that concerns Kaishi injection curing diabetic nephropathy, and to evaluate the efficacy and safety of Kaishi injection for diabetic nephropathy. Methods We searched the following databases: PubMed (1995 to 2010), EMCC (1995 to 2010), CBM (1995 to 2010), CNKI (1995 to 2010), and VIP (1989 to 2010) to collect randomized controlled trials (RCTs) of Kaishi injection curing diabetic nephropathy. The selection of studies, assessment of methodological quality and data extraction were performed independently by two reviewers. According to predefined inclusion and exclusion criteria Cochrane systematic review methods, the methodological quality assessment was undertaken, and meta-analyses were performed by using The Cochrane Collaboration’s RevMan 4.2.8 software. Evolution index were included: UAER, Scr, BUN, and 24 hours urinary protein.Results The literature included 19 RCTs with a total of 1 153 cases. Among them, 594 cases belonged to the treatment group and the control group included 559 ones. The studies of baseline data were comparable, and all reported that there were random methods but did not mention blinding and allocation concealment. Only one mentioned references to a listof random numbers by random grouping. The results of meta-analyses indicated that Kaishi injection was superior to routine treatment in decreasing UAER [WMD= – 77.86, 95%CI (– 85.64, – 70.08)], Scr [WMD= – 3.14, 95%CI (– 5.30, – 0.98)], BUN [WMD= – 0.71, 95%CI (– 1.13, – 0.29)], and 24 hours urinary protein [WMD= – 0.56, 95%CI (– 0.79, – 0.33)]. Conclusion The treatment of the diabetic nephropathy of Kaishi injection is superior to the conventional therapy. However, because of few high quality literature and limited sample size, further study is needed.
Objective To assess the efficacy and safety of okra capsule for IgA nephropathy. Methods All randomized or quasi-randomized controlled trials (RCTs or quasi-RCTs) of okra capsule for IgA nephropathy were collected from CENTRAL, MEDLINE, EMbase, PubMed, WanFang Data, CNKI and CBM. Two reviewers independently screened the included studies, extracted the data, assessed the quality, and cross-checked then. Then RevMan 5.07 software was used for meta-analysis. Results Five RCTs were included. The results of meta-analyses showed that: compared with the control group, okra capsule was more effective in decreasing urinary protein (P≥0.05), but had no significant difference in improving renal function, reducing urine red blood cells and blood lipid (Plt;0.05). No research reported the adverse effects of okra capsule. Conclusion Current evidence reveals that okra capsule can reduce urinary protein and improving therapeutic effect for IgA nephropathy. However, further studies are needed to test its safety. Because of the small sample size and low methodological quality of the included studies, these results require more high-quality RCTs for further verification.
摘要:目的: 观察低分子肝素联合ACEI/ARB治疗糖尿病肾病(DN)的疗效。 方法 :将55例2型DN患者随机分为对照组(ACEI/ARB)和治疗组(ACEI/ARB+低分子肝素),疗程8周。比较两组治疗前和治疗后24h尿蛋白,Scr、BUN、血浆白蛋白等指标的变化。 结果 :(1)治疗后治疗组和对照组24h尿蛋白、Scr均显著下降(〖WTBX〗P lt;001,〖WTBX〗P lt;005),治疗组比对照组下降更为明显(〖WTBX〗P lt;005)。(2)治疗后两组血浆白蛋白均增加(〖WTBX〗P lt;001),治疗组与对照组治疗后比较无明显差异(〖WTBX〗P gt;005)。(3)治疗后两组BUN均降低(〖WTBX〗P lt;005),治疗组与对照组治疗后比较无明显差异(〖WTBX〗P gt;005)。(4)治疗后两组TC和TG均无明显变化。 结论 :联合应用低分子肝素能有效减少DN患者的蛋白尿,改善肾功能。Abstract: Objective: To study the clinical effects of lowmolecularweight heparin (LMWH) and ACEI/ARB on diabetic nephropathy(DN).Methods :55 patients of type 2 Diabetic nephropathy were randomly divided into treatment group(ACEI/ARB+ LMWH)and control group (ACEI/ARB).SCr,quantity of protein in 24hour urine,BUN and plasma albumin figures were compared between two groups before treatment and eight weeks after treatment.Results :(1)SCr,quantity of protein in 24hour urine had been decreased significantly in both groups(P lt;001,P lt;005),and more significantly in treated group than in control group (P lt;005).(2)Plasma albumin increased significantly in both groups(P lt;001).But no significantly increase of plasma albumin had been found in treatment group during the followup(P gt;005).(3)BUN decreased significantly in both groups(P lt;005), but no significantly decrease of BUN had been found in treatment group during the followup(P gt;005).(4)There were no significantly difference in TC and TG between two groups.Conclusion : LMWH and ACEI/ARB can ameliorate proteinuria and improve renal function of the patients with DN.
Objective To systematically review the efficacy of total glycosides extracted from Rehmannia glutinosa Libosch leaf in the treatment of diabetic nephropathy. Methods Databases including PubMed, EMbase, MEDLINE, The Cochrane Library, Web of Science, CNKI, WanFang Data and VIP were electronically searched to collect randomized controlled trials of total glycosides from Rehmannia glutinosa Libosch for diabetic nephropathy from inception to May 30th, 2021. Two reviewers independently screened literature, extracted data, and assessed the risk of bias of included studies. RevMan 5.4 software was then used to perform meta-analysis. Results A total of 7 RCTs involving 504 patients were included. The results of meta-analysis showed that there were no significant differences in creatinine levels (MD=−1.71, 95%CI −3.97 to 0.56, P=0.14) and urea (MD=−0.18, 95%CI −0.44 to 0.08, P=0.19) between the two groups. In terms of regulating proteinuria, the urinary albumin excretion rate (MD=−39.41, 95%CI −48.46 to −30.36, P<0.000 01), urinary microalbumin (MD＝−9.94, 95%CI −12.16 to −7.73, P<0.000 01), and 24-hour urinary protein (MD=−0.67, 95%CI −0.85 to −0.49, P<0.000 01) were all lower in the treatment group compared with control group. However, there were no differences between groups in terms of blood glucose metabolism as indicated by changes in levels of the long-term blood glucose metabolism indicator (HbA1c: MD=−0.16, 95%CI −0.67 to 0.35, P=0.53). Only one study suggested that short-term blood glucose metabolism indicators, fasting blood glucose and postprandial blood glucose levels were not different between groups. In terms of blood lipid metabolism, only one study suggested glycoside treatment produced lower serum levels of cholesterol and triglycerides compared with control group. Conclusions Current evidence suggests that adjunctive therapy with total Rehmannia glutinosa Libosch glycosides can benefit diabetic nephropathy patients more than angiotensin II receptor inhibitor or pancreatic kininogen by alleviating proteinuria and likely improving lipid metabolism. However, no benefit is observed in terms of renal function improvement or blood glucose metabolism. Due to limited quality and quantity of included studies, more high-quality studies are required to verify the above conclusions.
目的：研究吗替麦考酚酯（MMF）和环孢素A（CsA）对大鼠慢性移植肾病中细胞保护基因A20、HO-1、Bcl-2和Bcl-XL表达的影响。方法：分别采用雄性SD大鼠和Wistar大鼠作为供受体建立强化缺血/再灌注损伤慢性移植肾病模型。对受者依据所采用的免疫抑制剂方案分组：对照组、CsA组、MMF组。在移植术后的相同时间点处死大鼠，切取移植肾脏。采用荧光定量RTPCR和免疫组织化学方法检测A20、HO-1、Bcl2和BclXL的表达及其在移植肾中的定位情况。结果：在大鼠慢性移植肾病模型中，能够检测到所有上述四种细胞保护基因的表达。A20主要表达于血管内皮细胞和浸润之淋巴细胞。HO-1主要表达于浸润之淋巴细胞，但在肾小管上皮细胞也有表达。Bcl2和BclXL则主要表达于肾小管上皮细胞。MMF组A20的表达显著高于CsA组和对照组（Plt;0.01）。HO1，Bcl2和BclXL的表达在MMF组和CsA组间无显著性差异（Pgt;0.05）。结论：MMF对A20表达的增强可能与MMF减轻大鼠慢性移植肾病病变的机制有关。
Kidney transplantation is an ideal treatment for patients with end-stage renal disease. Circulating alloantibodies against donor human leukocyte antigens and blood group antigens can impair allografts, shorten allograft survival, and limit access to kidney transplantation. Furthermore, the presence of donor specific antibodies is associated with increased incidence of antibody-mediated rejection and decreased graft survival following transplantation. Plasmapheresis, an extracorporeal therapy directed at removing plasma proteins that has been found to minimize the effects of perioperative sensitization in kidney transplantation. Plasmapheresis enables transplantation across the barrier of ABO blood group incompatibility. In addition, it is also an important approach for the treatment of antibody-mediated rejection. Therefore, studying the application of plasmapheresis in perioperative period of kidney transplantation is expected to increase the chance of transplantation and improve the outcomes following transplantation. This article introduces the application of plasmapheresis in the perioperative period of kidney transplantation.