Objective To evaluate the efficacy and safety of tripterygium for diabetic nephropathy. Methods All randomized or quasi-randomized controlled trials (RCTs or quasi-RCTs) of tripterygium for biabetic nephropathy were collected from The Cochrane Library (Issue 1, 2010), MEDLINE (1996 to March 2010), CNKI (1994 to March 2010), and CBM (1978 to March 2010). Two reviewers evaluated the quality of the trials and extracted the data independently. RevMan 5.0 software was used for meta-analyses. Results A total of 12 RCTs involving 862 patients were identified. The methodology of the included trials was poor and potential publication bias existed. The meta-analyses results showed: (1) Compared with the conventional treatment, the tripterygium showed more effects in reducing the 24-hour urinary protein (Clinical phase: WMD= –0.49, 95%CI –0.63 to –0.34, No phase: WMD= –0.60, 95%CI –0.96 to –0.24), and the urinary albumin excretion rate (UAER) (WMD= –148.75, 95%CI –238.01 to –59.48) was higher than that of the conventional treatment. (2) There were no significant differences between the two groups in the effect on the serum creatinine (Clinical phase: WMD= –8.43, 95%CI –18.15 to 1.29, No phase: WMD= –0.66, 95%CI –2.12 to 0.79) and creatinine clearance rate (WMD= 1.74, 95%CI –6.34 to 9.83). (3) Without enough data, it was uncertain to define the effect of tripterygium on lipids, blood pressure of the DN patients. (4) No severe adverse events or allergic reactions were reported. Conclusion Tripterygium may be a kind of medicine relatively safe and effective for diabetic nephropathy. However, the evidence is not b enough because of some low-quality trials and publication bias. Rigorously-designed, randomized, double-blind, and placebo-controlled trials of tripterygium for diabetic nephropathy are needed to further assess the effect.
Although anaphylaxis induced by vitamin K1 seldom happens, 4 allergic cases were observed in the patients we treated recently who were given intramuscular injection of vitamin K1 before renal biopsy. To provide the best clinical evidence, we searched MEDLINE （-May 2005） and evaluated the studies. The studies were only case reports and retrospective reviews which showed the anaphylaxis were mainly allergic dermatitis with different manifestation and reaction time. The serious reactions such as allergic shock was very rare. We conclude that although vitamin K1 anaphylaxis is rare, strict indications should be followed and the drug surveillance on adverse events should be strengthened.
Objective To evaluate the effectiveness and safety of reduced glutathione in the treatment of acute renal failure. Methods Twenty-three patients with acute renal failure were divided into the treatment group (n=10) and the control group (n=13) by simple randomisation. Patients in the treatment group received intravenous reduced glutathione 1200 mg daily. Patients in the control group were not treated with reduced glutathione. The therapeutic course for both groups was 4 weeks. Serum creatinine and urea nitrogen were determined before treatment as well as at the end of each of the 4 weeks. Proximal and distal renal tubular functions were evaluated at the end of the treatment. The time when clinical symptoms were improved was recorded and adverse drug reactions were monitored. Results The durations of nausea and vomiting as well as the oliguria stage were shorter in the treatment group than in the control group. The serum creatinine level in the treatment group decreased more markedly than that in the control group. At the end of the treatment, the renal tubular function was better in the treatment group than in the control group. Conclusion Reduced glutathione contributes to the early recovery of renal function in patients with acute renal failure. However, more high-quality and large-scale randomized controlled trials are needed.
Objective To assess the effectiveness and safety of mycophenolate mofetil (MMF) in the treatment of proliferative lupus nephritis. Methods We searched CBM (November 1979 to February 2006), Chinese Cochrane Centre Database (2005), The Cochrane Library (Issue 4, 2005), MEDLINE (November 1966 to February 2006) and EMBASE (1975 to February 2006) for randomize controlled trials. Data were extracted and analyzed using The Cochrane Collaboration’s RevMan 4.2.7. Results Nine randomize controlled trials involving 512 patients met the inclusion criteria. The meta-analysis showed that the total clinical effective rate and complete remission rate were not significantly higher for MMF than for cyclophosphamide, azathioprine, or both. Renal survival rate and relapse rate of MMF were not significantly different from those for cyclophosphamide, azathioprine, or both. Patient survival rate and safety of MMF were significantly improved compared with cyclophosphamide, azathioprine, or both. Conclusion More large-scale multi-center randomized trials are needed to investigate the role of MMF in the treatment of proliferative lupus nephritis.