Comparison Of The Curative Effect Of Kunxian Capsule And Prednisone In The Treatment Of IgA Nephropathy

BackgroundIgA nephropathy is one of the most common primary glomerular diseases in the world.About 20-30%of patients will develop into End Stage Renal Disease（ESRD）with the prolongation of the disease.In the latest KDIGO guidelines,it is pointed out that for patients with IgA nephropathy who are at high risk of developing chronic kidney disease（CKD）with maximum supportive treatment,corticosteroids or immunosuppressants therapy should be considered,However,due to the serious adverse effects of corticosteroids and some patients’steroids Intolerance or non-acceptance,the widespread use of corticosteroids is restricted.Kunxian capsule is a kind of plant immunosuppressant,which belongs to the new generation of Tripterygium wilfordii compound preparation.In recent years,Kunxian capsule has been gradually used in the treatment of nephropathy and achieved satisfactory results in related kidneys,but its application in IgA nephropathy is relatively less,and the specific efficacy and side effects of the drug are not clear.ObjectiveTo investigate the short-term efficacy and safety of Kunxian capsule in the treatment of IgA nephropathy.MethodsThis study selected Sixty-three patients with primary IgA nephropathy diagnosed in the Nephrology Hospital of the First Affiliated Hospital of Xin Xiang Medical University from October 2018 to April 2020 and whose 24H urine protein was 1.0-3.5g.They were randomly divided into the prednisone group（n=32）and the Kunxian group（n=31）.The prednisone group was treated with prednisone acetate tablets and Kunxian group was treated with Kunxian capsule.Both groups were treated continuously for 12 weeks.The changes of 24H urinary protein,serum creatinine,serum uric acid,serum urea,Cystatin C,alanine aminotransferase,aspartate aminotransferase,serum albumin,fasting blood glucose and blood routine were observed before and after treatment.At the same time,adverse drug reactions were observed.Results1.Comparison of the changes of urinary protein between the two groups before and after treatment.At 4 weeks,the median amount of 24H urinary protein level in Kunxian group and prednisone group were 0.75g and 0.70g respectively,which were significantly different from those before treatment（P<0.05）,but there was no significant difference between the two groups.At 12 weeks,the difference of median urinary protein was higher in the Kunxian group than in the prednisone group（1.09g vs 0.89g;P<0.05）,percentage change in proteinuria was significantly different between the Kunxian group and the prednisone group（83.61%vs 71.97%;P<0.05）.The median 24H urinary protein level was lower in Kunxian group than in prednisone group（0.24g vs 0.40g;P<0.05,respectively）,and there were significant differences between the two groups before treatment（P<0.05）.2.Comparison of the changes of serum albumin between the two groups before and after treatment.At 12 weeks,the serum albumin level was lower in the prednisone group than in the Kunxian group([44.54±3.44]g·L^-1vs[41.68±2.52]g·L^-1;P<0.05),and The level of serum albumin in prednisone group was higher than that before treatment([44.54±3.44]g·L^-1vs[41.95±4.33]g·L^-1;P<0.05).There was no significant difference in serum albumin level in Kunxian group compared with that before treatment.3.Comparison of the levels of serum creatinine,serum uric acid,serum urea,Cystatin C,fasting blood glucose,hemoglobin,glutamic pyruvic transaminase and glutamic oxaloacetic transaminase between the two groups.During the treatment,the levels of serum creatinine,blood urea,cystatin C,glutamic pyruvic transaminase and glutamic oxaloacetic transaminase fluctuated in the normal range,and there was no significant difference in fasting blood glucose,hemoglobin and serum uric acid between groups before and after treatment（P>0.05）.4.Comparison of efficacy and short-term safety between the two groups.At 12 weeks,the complete remission rate was significantly higher in the Kunxian groupthan than in the prednisone group（64.52%vs 34.38%;P<0.05）.The incidence of total adverse reactions was significant difference between the Kunxian group and the prednisone group（3.23%vs 28.13%;P=0.013）.ConclusionKunxian capsule can significantly reduce the 24-hour urinary protein level in patients with IgA nephropathy within 3 months.It has good short-term curative effect,quick effect and less adverse reactions.Compared with prednisone,Kunxian capsule has a higher complete remission rate.