The efficacy and safety of tacrolimus （TAC） and cyclophosphamide （CTX） in the treatment of idiopathic membranous nephropathy （IMN） were compared in Chinese adult patients using a meta-analysis of the available literatures. Randomized controlled clinical trials （RCTs） of the treatment of primary IMN with TAC or CTX combined with corticosteroids in the English databases PubMed, Embase and Cochrane, as well as Chinese databases, were searched. Qualified studies were subjected to quality assessment and meta-analysis. A total of 8 RCTs, including 359 Chinese patients, were included in the meta-analysis. The complete remission rate and overall remission rate in the TAC treatment group after 6 months of treatment were higher than those in the CTX treatment group. No significant difference in remission rate was found after 12 months of treatment. There was no significant difference in the adverse reaction between the two groups at the 6th or 12th months. TAC-based treatment was associated with a faster response than CTX at the 6th month, but there was no significant difference between the two groups at 12th month in Chinese adults. Further study is needed to evaluate the long-term efficacy and safety of this treatment regimen.
This study investigated the variation of serum monocyte chemoattractant protein-1（MCP-1） in patients with both diabetes mellitus（DM） and metabolic syndrome（MS）.Based on the International Diabetes Federation（IDF） diagnostic criteria,93 patients enrolled in this study were divided into four groups：normal control（NC）,simple DM,simple MS,and DM plus MS（DM-MS） groups.The main measures included height,weight,waist circumference（WC）,hip circumference,blood pressure,fasting blood glucose,insulin resistance index（HOMA-IR）,serum triglyceride（TG）,HDL-ch,LDL-ch,and MCP-1.The results showed that the serum levels of MCP-1 in the DM-MS group were significantly increased as compared with those in the DM and MS groups（P0.05）,and the increase in the MCP-1 level in the DM group was much higher than in the MS group（P0.05）.The DM-MS group had the highest HOMA-IR levels,followed by MS,DM and NC groups（P0.05）.Correlation tests showed that the association of MCP-1 with age,HDL-ch,or LDL-ch was insignificant,whereas that of MCP-1 with body mass index（BMI）,waist hip rate（WHR）,WC,systolic blood pressure（SBP）,diastolic blood pressure（DBP）,TG,and HOMA-IR was significantly positive.It was concluded that circulating MCP-1 was substantially increased in patients with both DM and MS as compared with that in the patients with DM or MS alone,and the central obese state may contribute to a more vicious proinflammatory condition and insulin resistance in patients with diabetes.
The correlations between the clinicopathological features and the long-term outcomes of renal amyloidosis（RA） were analyzed with a view to develop strategies for improving diagnosis and prognosis of RA. We retrospectively reviewed the clinicopathological characteristics of 47 patients diagnosed with RA between 2004 and 2014 at the Wuhan Union Hospital. The data on the renal histology, clinical manifestations, and prognosis of RA patients were retrieved from the hospital records and characteristic patterns were identified. The histological changes in the kidneys were correlated with the clinical manifestations of RA. Additionally, most RA patients in this study had decreased serum levels of κ light chain and increased urine levels of κ and λ light chains as well as presence of M-protein in the urine and serum. Patients with early RA showed no specific pathognomonic symptoms. Bleeding associated with diagnostic renal biopsy was rare. We recommend that the routine work-up of patients aged over 40 years and presenting with non-diabetic nephropathy includes the non-invasive tests for the measurement of serum and urine levels of κ and λ light chains as well as protein electrophoresis tests for the presence of urinary and serum M-protein. Additionally, such patients should undergo renal biopsy screening with Cong-red staining to ensure early diagnosis of RA and improve their survival, since the risk of hemorrhage related to renal biopsy screening is low at early stages of RA.
