| Objective:To observe the clinical efficacy and safety of double filtration plasmapheresis in the treatment of recurrent Ig A nephropathy after renal transplantation.Methods:A retrospective analysis was performed on 19 patients with recurrent Ig AN after renal transplantation who were hospitalized in the renal transplantation ward of the Department of Urology of our hospital from January 2018 to December 2020,and they were divided into double filtration plasmapheresis group(9cases)and control group(10 cases)according to different treatment regiments.Both groups were given conventional treatment,in which the control group was given Tripterygium wilfordii polyglycoside tablets(Suzhou Yifan Pharmaceutical Co.,LTD.)1 ～ 1.5mg/kg·d,divided into three times after meals,and maintenance treatment was stopped after 6 months.On the basis of the control group,the double filtration plasmapheresis group was given double filtration plasmapheresis therapy before treatment,every patient was treated once every other day,2-3 times per week.Retrospectively collected before the treatment of the patient’s age,sex,blood pressure,blood sugar and the laboratory indexes such as clinical data and treatment of the patients were observed 1 months,3 months and 6 months when the 24h-urine protein,serum creatinine,blood urea,quantitative indices such as serum albumin and clinical effectiveness of change,at the same time pay attention to the record related adverse reactions.Results:1.Clinical efficacy:After 1 month of treatment,there were 4 cases of complete remission,4 cases of partial remission and 1 case of no remission in the double filtration plasmapheresis group,and the total clinical response rate was 88.89%.In the control group,there was 1 case of partial remission and 9 cases of no remission,and the total clinical response rate was 10.00%.The total response rate in the double filtration plasmapheresis group was higher than that in the control group,and the difference was statistically significant(P < 0.05).After 3 months of treatment,there were 3 cases of complete remission,5cases of partial remission and 1 case of no remission in the double filtration plasmapheresis group,and the total clinical response rate was 88.89%.There were 2 cases of partial remission and 8 cases of no remission in the control group,and the total clinical response rate was 20.00%.The total response rate in the double filtration plasmapheresis group was higher than that in the control group,and the difference was statistically significant(P < 0.05).At 6 months after treatment,there were 3 cases of complete remission,4cases of partial remission and 2 cases of no remission in the double filtration plasmapheresis group,and the total clinical response rate was 77.78%,while there were 5 cases of partial remission and 5 cases of no remission in the control group,and the total clinical response rate was 50.00%.There was no statistical significance in the total effective rate between the two groups(P > 0.05).2.Clinical Indicators:(1)Comparison of 24h-urine protein level between the two groups before and after treatment: at 1,3 and 6 months after treatment,24h-urine protein level in the two groups was lower than that before treatment,with statistical significance(P < 0.05);At 1,3 and 6 months of treatment,there were statistically significant differences in 24h-urine protein levels between 2 groups(P < 0.05).(2)Comparison of serum albumin levels between the two groups before and after treatment: at 1,3 and6 months after treatment,serum albumin levels in double filtration plasmapheresis group were slightly higher than those before treatment,with statistical significance(P < 0.05);At 1 month after treatment,serum albumin level in control group was slightly higher than that before treatment,but the difference was not statistically significant(P > 0.05).At 3 and 6 months after treatment,serum albumin level in control group was slightly higher than that before treatment,with statistical significance(P < 0.05).At 1,3 and 6months of treatment,there was no statistical significance in serum albumin levels between 2 groups(P >0.05).(3)Comparison of serum creatinine,blood urea and estimate glomerular filtration rate levels between 2groups before and after treatment: there were no significant differences in serum creatinine,blood urea and estimate glomerular filtration rate levels within and between groups before and after treatment(P > 0.05).3.Adverse reactions:In the double filtration plasmapheresis group,3 patients had adverse reactions,including 1 patient with hypotension,1 patient with gastrointestinal reaction,and 1 patient with menstrual disorder.The total adverse reactions rate was 33.33%.In the control group,there were 2 patients with adverse reactions,1patient with abnormal liver function and 1 patient with gastrointestinal reactions,with a total adverse reaction rate of 20.00%.The total rate of adverse reactions in double filtration plasmapheresis group was higher than that in control group,and there was no statistical significance(P > 0.05).Conclusion:1.Double filtration plasmapheresis can effectively reduce urinary protein level,increase serum albumin and maintain stable renal function in patients with recurrent Ig A nephropathy after transplantation.2.Compared with the control group,the double filtration plasmapheresis group increased the remission rate of recurrent Ig A nephropathy after transplantation,reduced urinary protein levels more quickly,increased serum albumin earlier,maintained stable renal function,and did not increase the incidence of short-term adverse reactions. |
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