Effection Of Urinary Angiotensinogen Level In HSPN Children With Combined Treatment Of Traditional Chinese Medicine And Western Medicine

Objective To investigate whether renal renin-angiotensin system(RAS) and reactive oxygen species(ROS) were involved in the kidney injury of Henoch Schonlein Purpura Nephritis(HSPN) in children, and the possible mechanism of Angiotensin Converting Enzyme Inhibitors(ACEI) or Angiotensin Ⅲ type Ⅰ Receptor Blocker(ARB) and the traditional Chinese medicine syndrome differentiation treatment.Methods 25 children with HSP and 87 children with HSPN who had renal biopsy surjery were observed in the department of pediatrics of the First Affiliated Hospital of Henan University of traditional Chinese medicine from 2014 August to 2015 April, and the children’s age range from 5 to16 years old. Collecting morning urine of HSP patients on the day when confirmed diagnosis, but HSPN patients’ sample collected on the day or the day before renal biopsy surjery and two weeks after treatment. At the same time,12 normal children’s urine as a normal control(NC) group. The ELISA method was used to text urinary angiotensinogen(uAGT), urinary Methane Dicarboxylic Aldehyde(uMDA) in the HSPN group, urinary collagen type Ⅳ(uCL-Ⅳ) and urinary laminin(uLN) levels in the NC, HSP and HSPN group. Compared the differences of indexs mentioned above between HSPN with or none crescents groups, different crescents proportion(≤25% and >25%) groups. Analyzed the correlation between uAGT and uCL-Ⅳ, uMDA. uCL-Ⅳ and microalbuminuria, urinary immune globin G. Besides conventional western medicine treatment, the all HSPN patients were devided into the treatment group Ⅰ(Xijiao Dihuang Decoction), the treatment group Ⅱ(Xijiao Dihuang Decoction+ACEI/ARB), the treatment groupⅢ(Yupingfeng Powder and LiuWei Dihuang Decoction), the treatment groupⅣ(Yupingfeng Powder and LiuWei Dihuang Decoction+ACEI/ARB), according to the combined drugs. The above-mentioned indexs and 24-hours proteinuria were analyzed in HSPN before and after treatment. The all indexes mentioned above were corrected with urine creatinine(Cr)ratio. Statistical analysis was performed with SPSS17.0 software package.Results①The uIV/Cr and uLN/Cr levels were obviously higher in children with HSPN before treatment than in healthy children and children with HSP(P<0.05), no significant difference between HSP group and NC group.②The levels of uCL-Ⅳ/Cr, uAGT/Cr were obviously higher in HSPN with crescents compared with none crescents, the same result in>25% crescents group compared with≤25% crescents group (P<0.05). uMDA/Cr was higher in group with crescents compared with none crescents (P<0.05), but no difference in>25% crescents group and ≤25% crescents group. There is no difference of uLN/Cr in the mentioned-above comparison.③The level of uAGT/Cr was positively correlated with uCL-IV/Cr and uMDA/Cr. uCL-Ⅳ/Cr was positively correlated with microalbuminuria/Cr, and urinary immune globin G/Cr. ④The concentrations of 24 hours urinary protein and uMDA/Cr in each group after treatment were significantly decreased (P<0.05). Except the treatment group I, the uAGT/Cr levels were significantly decreased in other three groups after treatment (P<0.05). But uCL-IV/Cr, uLN/Cr has no difference.⑤Compared the treatment group I with the treatment group II, the treatment groupⅢ with the treatment groupIV, the levels of uAGT/Cr, uMDA/Cr,24 hours urinary protein were significantly lowered by ACEI/ARB (P<0.05). Compared the treatment group I with the treatment group Ⅲ, the treatment group II with the treatment group IV, the levels of uAGT/Cr and uMDA/Cr were significantly decreased by treatment of Yupingfeng Powder and Liuwei Dihuang Decoction(P<0.05).Conclusion ① Renal RAS and ROS activation were involved in the kidney injury of children with HSPN. ②The higher uAGT of HSPN may be correlated with ROS and crescent formation (serious disruption of glomerular basement membrane). ③Combined traditional Chinese and western medicine with Yupingfeng Powder and Liuwei Dihuang Decoction can obviously inhibit the uAGT and uMDA. The mechanism may be reducing the leakage and secretion of uAGT by the antioxidant effect of these drugs, blocking the activation of the renal RAS, and protecting the kidney.