Background Mycophenolate mofetil （MMF） and cyclophosphamide （CTX） are widely used in treating various kidney diseases.However,whether they are effective and which one is better for treating IgA nephropathy patients with proliferative pathological phenotype in renal diseases,such as endocapillary proliferation,cellular crescents,and/or capillary loops fibrinoid necrosis is still unknown.We,therefore,initiated a study to compare the effects of MMF and CTX in treating IgA nephropathy with the above pathological lesions.Methods One hundred and nineteen patients with IgA nephropathy who had at least one of the three aforementioned lesions were enrolled.All patients were treated with prednisone; 48 patients received prednisone only （Pred group）,40 received MMF and prednisone （MMF ＋ Pred group）,and 31 were treated with CTX and prednisone （CTX ＋ Pred group）.The median time of follow-up was 30 months （maximum：96 months）.The primary endpoint was defined as renal survival.The incidence of remission of proteinuria was the secondary endpoint.Results Serum creatinine in all groups declined significantly at different follow-up times （P=0.002）,and the differences among the three groups were significant （P＜0.001）.At 24 months of follow-up,the decline rates were 12.35％,32.95％,and 24.14％ in the Pred,MMF ＋ Pred,and CTX ＋ Pred groups respectively.For urine protein excretion,the decline rates were 49.12％ （Pred）,73.67％ （MMF ＋ Pred）,and 63.53％ （CTX ＋ Pred） respectively at 24 months of follow-up.The differences among the three groups were not significant （P=0.714）.Renal survival （the primary endpoint） was significantly different （P=0.027）; however,the sencondary endpoint was similar for all the three groups （P=0.100）.Conclusions For IgA nephropathy patients with endocapillary proliferation,cellular crescents,and/or fibrinoid necrosis of capillary loops,prednisone combined with MMF was more effective in lowering the serum creatinine than with CTX.Combi
Liang Yan Zhang Junjun Liu Dongwei Quan Songxia Xing Guolan Liu Zhangsuo
Background Dyslipidemia, a well-known risk factor for cardiovascular disease, is common in patients with kidney disease. Recent studies discerned that dyslipidemias play a critical role in renal damage progression in renal diseases, but the association between dyslipidemias and chronic kidney disease （CKD） in the general population remains unknown. Thus, we assessed whether the growing prevalence of dyslipidemia could increase the risk of CKD.Methods A total of 4779 middle-aged and elderl-yparticipants participated in this study. Dyslipidemias were defined by the 2007 Guidelines in Chinese Adults. Incident CKD was defined as albuminuria and/or reduced estimated glomerular filtration rate （eGFR, 〈60 ml.minl^-1.73 m^2）. Regression analysis was used to evaluate the association between dyslipidemia and albuminuria/reduced eGFR.Results Participants with hypercholesterolemia exhibited a greater prevalence of albuminuria and reduced eGFR （10.0% vs. 6.1%, P=0.001; 4.0% vs. 2.4%, P=0.028, respectively）. Both hypercholesterolemia and low high density lipoprotein cholesterol （HDL-C） were independently associated with albuminuria （odds ratio （OR） 1.49; 95% confidence interval （CI） 1.08-2.07 and OR 1.53; 95% CI 1.13-2.09, respectively）. The multivariable adjusted OR of reduced eGFR in participants with hypercholesterolemia was 1.65 （95% CI 1.03-2.65）. As the number of dyslipidemia components increased, so did the OR of CKD： 0.87 （95% CI 0.65-1.15）, 1.29 （95% CI, 0.83-2.01）, and 7.87 （95% CI, 3.75-16.50） for albuminuria, and 0.38 （95% CI 0.21-0.69）, 1.92 （95% CI 1.14-3.25）, and 5.85 （95% CI 2.36-14.51） for reduced eGFR, respectively.Conclusions Our findings indicate that dyslipidemias increase the risk of CKD in the middle-aged and elderly Chinese population. Hypercholesterolemia plays an important role in reducing total eGFR. Both low HDL-C and hypercholesterolemia are associated with an increased risk for albuminuria.
LIU Dong-weiWAN JiaLIUZhang-suoWANG PeiCHENG Gen-yangSHI Xue-zhong
