The Preliminary Analysis Of The Progression Of Chronic Aristolochic Acid Nephropathy

Background and ObjectiveAristolochic acid(AA)- induced kidney disease, aristolochic acid nephropathy(AAN), is characterized pathologically by chronic interstitial fibrosis with few cell infiltration. It is believed that chronic AAN is difficult to be cured with the routine treatment for chronic renal failure. In recent years, a few of reports suggested that glucocorticoid steroid could retard the progression of renal impairment in patients with ANN. In this study, we used low-dosage steroid therapy in ANN patients with mild-to-moderate and severe chronic renal failure to observe the effects of the steroid on the progression of renal failure in chronic AAN.Methods58 chronic AAN patients in Peking Union Medical College Hospital from October 2000 to July 2008 were included in this study. According to the levels of serum creatinine before treatment, the patients were divided into mild-to-moderate group(n=44, Scr < 530umol/l) and severe group(n=14, Scr> 530umol/l).The mild-to-moderate group was devided into steroid group(SG, n=23, prednisolone 0.5mg/kg for 1-3 month ,tapered off 0.04mg/kg every month) and control group(CG, n=21). The gender ratio, average age and serum creatinine levels before treatment were similar in the two groups. In the observation period of 1 year, the serum creatinine levels were compared between the SG and CG groups to examine the effects of steroid on renal failure progression of AAN.The patients of severe group(n=14) all accepted steroid therapy. The serum levels of crteatinine before and after 1 year treatment were compared to test the effects of steroid on the progression of renal failure of AAN.The serum creatinine levels of all patients who were given steroid therapy were compared before and after treatment to evaluate the impact of steroid on the progression of chronic AAN. At the same time, the creatinine levels of mild-to-moderate group was compared to that of severe group to determine whether there was any difference of the benefits which was obtained from steroid therapy between different degrees of renal failure.ResultsIn the mild-to-moderate group, the creatinine levels of the patients accepted steroid therapy at the month 3, 6, 9 and 12 after therapy were not significantly different compared with that before therapy, respectively. During the first 3 months, the serum creatinine levels were decreased, then kept steadily. While the renal function of the CG patients kept deteriorating and the creatinine levels were obviously higher than that of the SG patients. The results got from the severe group and all steroid-received patients resembled that of the the mild-to-moderate group .Our data also showed that during the first 3 months steroid therapy the decrease of creatinine levels in severe group were more significant than that in mild-to-moderate group, but there was no such difference for the whole 1 year.During the steroid therapy, 4 cases of DM, 4 cases of herpes infection, 1 case of femoral head necrosis occurred in the mild-to-moderate group, and 1 case of serum glucose increasing occurred in the severe group.ConclusionsLow-dosage seroids therapy could reverse or delay the progression of renal failure in AAN both for mild-to-moderate CRF and sever CRF. The protective effect mainly occured in the first 3 months, and kept at least for 1 year. The side effects of low-dosage seroid therapy were not severe and could be toleranced to the AAN patients.