Objective To systematically review the methodological quality of guidelines concerning pharmacological intervention for complicated hypertension. Methods The databases and relevant guideline websites such as MEDLINE, EMbase, CBM, WangFang Data, National Guideline Clearinghouse (NGC), Guidelines International Network (GIN), National Institute for Health and Clinical Excellence (NICE) and Clinical Practice Guideline Network (CPGN) were searched to collect the clinical guidelines concerning pharmacological intervention for complicated hypertension. By adopting the Appraisal of Guidelines for Research and Evaluation (AGREE), the methodological quality of guidelines was assessed. Meanwhile the similarities, differences and features of drug recommendation in guidelines for different areas and diseases were analyzed by means of analogy comparison.Results A total of 21 guidelines concerning pharmacological intervention for complicated hypertension were included. The number of guidelines concerning hypertension complicated with coronary heart disease (CHD), stroke, diabetes mellitus (DM) and kidney disease (KD) was 5, 5, 7 and 4, respectively. The publication year ranged from 2000 to 2011. According to the AGREE instrument, 19 and 2 guidelines were graded as Level B and C, respectively. The overall guidelines got low average scores in the domain of “Stakeholder involvement” and “Applicability”, including 9 evidence-based guidelines. There were totally 4 and 3 classes in terms of the level of evidence and recommendation, respectively; moreover, 10 and 6 expression forms were adopted in the level of evidence and recommendation, respectively. For hypertension with angina pectoris, -blocker (BB) and calcium channel blocker (CCB) were recommended unanimously. For hypertension with myocardial infarction, angiotensin converting enzyme inhibitor (ACEI) and BB were recommended unanimously. For hypertension with heart failure, ACEI, angiotensin-receptor blocker (ARB) and BB were recommended unanimously. For hypertension with later stage of post-stroke, 76.47% guidelines recommended diuretic (D) and ACEI. For hypertension with acute stroke, recommendations were mainly based on the guidelines developed by American Heart Association/American Stroke Association (AHA/ASA). For hypertension with DM or KD, the guidelines basically recommended that systolic/diastolic pressure should be controlled in the range of less than 130/80 mmHg. For hypertension with DM, ACEI were recommended unanimously, followed by D and CCB. For hypertension with KD, ACEI/ARB was recommended, while 3 of the 5 guidelines recommending CCB were from Asian. Conclusion The overall methodological qualities of complicated hypertension guidelines differs, with high proportion of evidence-based guidelines. The classification criteria of the levels of evidence and recommendation are still suboptimal. For hypertension with CHD, DM, KD and later stage of stroke, results from high quality clinical evidence are consistent, and the recommendations are basically unanimous, with no regional and quality difference. But in some clinical researches beyond reaching a consensus at present, the recommendation discrepancy exists, and there still remains controversy for hypertension with acute stroke.
Objective To assess the efficacy of Tongxinluo for diabetic kidney disease. Methods we conducted a systematic review of randomized controlled trials (RCTs) in which Tongxinluo was used to treat diabetic kidney disease. And we screened relevant studies according to predefined inclusion and exclusion criteria, evaluated the quality of the included studies, and performed meta-analyses by using The Cochrane Collaboration’s Revman 5.0 software. Results A total of 11 RCTs were enrolled in the review. The results of meta-analysis showed that Tongxinluo was better on attenuating 24 hour urinary protein,BUN and UAER; Tongxinluo was not superior to no treatment on the improvement of Scr and Ccr; Tongxinluo was better than no treatment on the Regulation of blood lipids, such as TC, TG, LDL-C. However, Tongxinluo might have similar effects on the improvement of HDL-C; Tongxinluo was better than no treatment on the improvement of FBG, but xuezhikang was not superior to no treatment on the improvement of P2BG and HbA1c. Tongxinluo was better than no treatment in decreasing plasma endothelin (ET). No significant adverse effects or Allergic reactions were reported. Conclusion The evidence currently available shows that Tongxinluo has some effect and is relatively safe in treating patients with diabetic kidney disease.Due to a high risk of selection bias and detection bias in the included studies, the evidence is insufficient to determine the effect of Tongxinluo. Further large-scale trials are required to define the role of xuezhikang in the treatment of DKD.
Objective To assess the effectiveness of statins in treating early diabetic kidney disease (DKD). Methods We searched the Cochrane Central Register of Controlled Trials (Issue 2, 2009), MEDLINE (1991 to August 2009), EMbase (1991 to August 2009), CBMdisc (1991 to August 2009) and CNKI (1994 to August 2009). We also handsearched relevant journals and conference proceedings. Randomized controlled trials (RCTs) in which statins were used to treat patients with early DKD were collected. Then we screened the retrieved studies according to predefined inclusion and exclusion criteria, evaluated the quality of the included studies, and performed meta-analyses by RevMan 4.2 software. Results A total of 281 articles were found and 22 articles inolving 1838 patients were finally included. All these articles were regarded as low quality. We chose the random-effect model to conduct meta-analysis because significant heterogeneities were found among these articles. The results of meta-analysis showed that after treatment with statins, there were significant reductions in urinary albumin excretion rate (UAER) (WMD= –55.77, 95%CI –74.20 to –37.34, Plt;0.000 01), serum creatinine (Scr) (WMD= –4.34, 95%CI –6.74 to –1.94, P=0.000 4), C reactive protein (CRP) (WMD= –1.48, 95%CI – 2.32 to – 0.63, P=0.006), total cholesterol (TC) (WMD= –1.33, 95%CI –1.75 to –0.91, Plt;0.000 01), and triglyceride (TG) (WMD= –0.72, 95%CI-1.17 to -0.27, P=0.002) in group treatment compared with group control. Funnel-plot displayed a symmetrical figure, indicating there was no publication bias. No severe adverse effects were found in these articles except 12 patients with high level of transaminase which were cured after using hepatic protect therapy. Conclusion Currently available evidence shows that with the reduction of TC and TG, statins may decrease UAER and Scr in patients with early DKD and the reduction of CRP may be involved in the mechanism. Statins provide effective renal protection and no severe adverse effects in treating early DKD. However, due to lack of quality in the included studies, more studies of better quality should be conducted
Objective To study the association between the insertion(I)/deletion(D) polymorphism of the angiotensin-converting enzyme gene intron 16 (ACE/ID) and diabetic nephropathy (DN) among Chinese population by Meta-analysis. Methods Odds ratios of ACE/ID genotype distributions were analyzed in NIDDM or IDDM patients with and without DN. All the related studies on ACE/ID polymorphism and DN were identified while poor-qualified studies were excluded, and the risk of publication bias was estiMetad. The Meta-analysis software, RevMan 3.1, was applied for investigating heterogeneity among individual studies and summarizing effects across studies by proper statistical methods. Result The pooled odds ratios (with 95%CI) of DD vs ID + II and II vs ID + DD were 2.17 (1.74-2.70) and 0.49 (0.36-0.66) in NIDDM (12 studies), 3.92 (2.05-7.47) and 0.19 (0.09-0.43) in IDDM (3 studies) respectively (Plt;0.01). Conclusion In both NIDDM and IDDM, ACE/ID polymorphism is believed to be associated with diabetic nephropathy. The number of DN patients with DD genotype has been increased while that with II genotype decreased.
Objective To review the efficacy and safety of interventions for preventing infections in nephrotic syndrome using evidence-based principles for clinicians to practice easily. Methods We searched Cochrane controlled trials register database, MEDLINE, EMBASE and Chinese Biologic Medical database. Results Total 11 articles were obtained including RCTs, non-controlled clinical studies and traditional narrative reviews. No systematic review or meta-analysis was identified. Prophylactic interventions for reducing risks of infection in nephrotic syndrome included intravenous immunoglobulin, thymosin, traditional Chinese herb, lamivudine, pneumococcal vaccination and chemoprophylaxis. Conclusion At present, the studies about interventions for preventing infection in nephrotic syndrome were limited in quantity and poor in the quality of methodology, therefore, the promising conclusions were unavailable. Rigid randomized placebo-controlled clinical trials with blinding or systematic review or meta-analysis would be very necessary for further assessing the efficacy and safety of the prophylactic interventions for preventing infections in nephrotic syndrome
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 evaluate the effectiveness and safety of spironolactone for diabetic nephropathy. Methods We electronically searched CENTRAL (issue 3, 2008), MEDLINE (1950 to August 2008), EMbase (1984 to August 2008), CNKI (1994 to September 2008), and VIP (1989 to August 2008). We also checked the reference lists of all papers identified for further trials. Randomized controlled trials (RCTs) and quasi-RCTs were identified and analyzed according to the Cochrane Handbook for Systematic Reviews of Interventions. Results Three RCTs were included. Meta-analysis was not performed due to heterogeneity. Trials showed that spironolactone might decrease urinary albumin excretion, but could scarcely play an important role on kidney function and blood pressure. Conclusion Affirmative assessment cannot be made about the effectiveness and safety of spironolactone for diabetic nephropathy according to the limited existing trials. Large-scale, high-quality RCTs are needed to confirm or refuse the available evidence.
目的 分析朱砂莲中毒导致急性肾功能衰竭临床表现、肾脏病理学及相关文献复习。 方法 2007年3月－9月收治朱砂莲中毒急性肾功能衰竭2例，分析临床表现及肾脏病理损害。 结果 朱砂莲急性中毒易致急性肾功能衰竭，危及生命；其主要损害肾小管间质，表现为急性肾小管重度损伤，无炎性细胞浸润，而肾小球几乎无病变。 结论 朱砂莲为我国常使用中药，主要成分为马兜铃酸，易致马兜铃酸肾病，须提高对该病认识，规范使用中草药，避免药物性所致肾损害。Objective To analyze the clinical and pathological manifestations of kidney in patients with ciliatenerve knotweed root-induced acute renal failure. Methods Two patients who were admitted into our hospital for acute renal failure caused by over-dose ciliatenerve knotweed root from March to September in 2007 were included in this study. We analyzed the clinical and pathological manifestations of their kidneys. Results Over-dose ciliatenerve knotweed root could induce acute renal failure, even threaten life. The pathology of kidney is characterized by severe tubular injury,rather than glomerulus damage, without cell infiltration. Conclusions Ciliatenerve knotweed root is one of the frequently-used traditional Chinese medicines in our country, which can easily result in aristolochinc acid nephropathy. We should recognize the importance of this disease and avoid using nephrotoxic drugs.
【摘要】 目的 发现提示早期Ⅴ型狼疮性肾炎（lupus nephritis，LN）的指标。 方法 2004年 1月-2009年11月24例经肾活检诊断为Ⅴ型LN患者，与同期50例膜性肾病伴抗核抗体（antinuclear antibody，ANA）阳性患者、50例膜性肾病ANA阴性患者，以及13例膜性肾病ANA阳性且肾组织荧光为“满堂亮”患者的一般资料、肾病表现、肾脏病理以及实验室指标进行比较。 结果 Ⅴ型LN与膜性肾病ANA阴性的患者相比，两组的性别、起病年龄、血红蛋白、补体水平、内皮和系膜增殖的比例等有明显差异。膜性肾病ANA阳性患者的临床和病理表现更接近于ANA阴性的膜性肾病，但其性别比仍以女性居多。而膜性肾病ANA阳性伴“满堂亮”的患者在性别、肾病表现、血红蛋白、补体水平等方面与Ⅴ型LN更为接近。 结论 膜性肾病ANA阳性患者具有异质性，其中肾脏病理表现为“满堂亮”的患者可能系早期Ⅴ型LN。【Abstract】 Objective To find out the clinical and pathological characteristics of early pure class Ⅴ lupus nephritis (LN). Methods A total of 24 patients with pure class Ⅴ LN diagnosed between January 2004 and November 2009 were included, and were compared with 50 antinuclear antibody (ANA)-positive patients with membranous nephropathy (MN) and 50 ANA-negative patients with MN. The clinical and pathological characteristics, laboratory test results were compared between the two groups. Then, 13 patients with "full house" fluorescence in renal biopsy specimens were chosen from the group of ANA-positive membranous nephropathy, whose clinical characteristics and laboratory test were compared with class Ⅴ LN patients. Results There were significant differences in sex ratio, age, positive rate of hepatitis B surface antigen (HBsAg), levels of hemoglobin, white blood cell, platelet,complement, endothelial and mesangial proliferation between class Ⅴ LN and ANA-negative MN group. However, the sex ratio, levels of white blood cell, platelet were similar between class Ⅴ LN and ANA-positive MN group. The renal biopsy specimens in patients with ANA-positive MN with "full house" fluorescence were similar with those in the patients with class Ⅴ LN in sex ratio, renal injury, hemoglobin and complement and the positive rate of hepatitis B surface antigen. Conclusion The demographic information and clinical manifestations in patients with class Ⅴ LN were similar to those in patients with ANA positive MN, especially in the patients wiht ANA-positive MN with "full house" fluorescence in renal biopsy specimens.