| Objective: Idiopathic membranous nephropathy(IMN)is the most commonly diagnosed cause of nephrotic syndrome in non-diabetic adults throughout the world.Patients with less than 3.5 g of 24-hour proteinuria were once thought to have a reasonable prognosis with angiotensin converting enzyme inhibitor(ACEI)and angiotensin receptor blocker(ARB),but current research has revealed that during follow-up,more than 60% of MN patients who initially have non-nephrotic range proteinuria go on to acquire nephrotic range proteinuria and eventually experience classical MN’s natural course.It is especially crucial to investigate a more effective and less harmful treatment.Colquhounia root tablet(CRT)is a traditional Chinese medicine.Its main components include epicatechin and triptolide,with the effects of reducing urinary protein and improving renal function.In this study,by reviewing the clinical records of 44 patients with IMN,it could determine effectiveness and safety of CRT in the treatment of IMN with sub-nephrotic proteinuria.Methods: Retrospective analysis of 44 IMN patients with moderate proteinuria treated with CRT in combination with ACEI/ARB or ACEI/ARB alone.Among them,22 patients treated with CRT in combination with ACEI/ARB were enrolled in the treatment group,and 22 patients receiving ACEI/ARB alone were enrolled in the control group.The remission rate(complete or partial remission)was the main outcome observed,and proteinuria,serum albumin levels,estimated glomerular filtration rate(e GFR),and untoward effects were the secondary outcomes.Results: 1.During the first 3 months of treatment,there was no considerable difference in the level of urinary protein reduction between the two groups(p>0.05).At 6,9 and 12 months of medication,the 24-hour urine protein quantification was significantly lower in the treatment group than in the control group,0.79±0.63g/24 h versus 1.81±1.65g/24h(p=0.012),0.65±0.67g/24 h versus 1.59±1.44g/24h(p=0.026),0.52±0.48g/24 h versus1.57±1.42g/24h(p=0.008);there was no significant variation in the change of albumin levels between the two groups after 9 months of dosing(p>0.05),while after 12 months of treatment the albumin levels in the treatment and control groups were 35.39±2.04g/L versus 33.07±4.12g/L(p<0.05).2.At the 6th,9th and 12 th month of treatment,the overall remission rates were 68.2% versus 27.3%(p=0.016),72.7% versus 36.4%(p=0.015)and 77.3% versus 36.4%(p=0.006)in the treatment and control groups,respectively.2.According to the Kaplan-Meier method,the probability of overall remission at 12 months was higher in the treatment group than in the control group(p=0.014).3.Cox multivariate survival analysis showed that CRT treatment was an independent influence on proteinuria remission(HR=3.593,95%CI 1.184-10.899,p=0.024);gender,age,baseline urine protein,baseline e GFR and baseline antiphospholipase A2 receptor(anti-PLA2R)levels were not shown to affect the outcome(p>0.05).4.In addition,in patients positive for anti-PLA2 R,overall remission rate after12 months of treatment was significantly higher in the treatment group than in the control group(75% versus 23.08%,p=0.017).5.In this study,a total of 7 cases(15.91%)of related adverse reactions were found during the follow-up period,of which 3 cases(13.64%)were found in the treatment group and 4 cases(18.18%)in the control group,with no statistical difference in the incidence of adverse reactions between the two groups(p>0.05);2 cases of menstrual disorders and 1 case of liver function impairment were observed in the treatment group,1 case of liver function impairment and 3 cases of hypotension were noticed in the control group.Conclusion: The addition of CRT to supportive therapy for sub-nephrotic level of proteinuria in IMN resulted in higher remission rates without an increased risk of adverse events. |
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