Ntu 1: Lub hnub qub sim qhia tias Kev Kho Mob Hloov Kho Nrog Corticosteroids Thiab Cyclophosphamide Zoo Tshaj Rau Kev Kho Mob Sequential Nrog Tacrolimus Thiab Rituximab hauv Thawj Membranous Nephropathy

Ntu 1: Kev sim STARMEN qhia tias kev hloov pauv kev kho mob nrog corticosteroids thiab cyclophosphamide yog qhov zoo tshaj rau kev kho mob raws sij hawm nrog tacrolimus thiab rituximab hauv thawj membranous nephropathy

Hu rau:joanna.jia@wecistanche.com/ WhatsApp: 008618081934791

Gema Ferna'ndez-Jua'rez, thiab lwm yam.

Ib tug cyclical corticosteroid -cyclophosphamideTxoj cai tau pom zoo rau cov neeg mob nrogthawj membranous nephropathyntawm kev pheej hmoo ntawm kev nce qib. Peb tau pom tias kev kho mob ua ntu zus nrog tacrolimus thiabrituximabyog superior rau cyclical alternating kho nrogcorticosteroidsthiabcyclophosphamidenyob rau hauv inducing persistent remission nyob rau hauv cov neeg mob no. Qhov no tau sim nyob rau hauv randomized, qhib-label tswj kev sim ntawm 86 cov neeg mob nrogthawj membranous nephropathythiab mob nephrotic syndrome tom qab kev soj ntsuam rau 6 lub hlis thiab muab 43 txhua tus tau txais kev kho mob rau lub hlis nrog corticosteroid thiabcyclophosphamidelos yog ua raws li kev kho mob nrogtacrolimus(tag nrho koob tshuaj rau rau lub hlis thiab tapering rau lwm peb lub hlis) thiabrituximab(ib gram ntawm lub hli rau). Thawj qhov tshwm sim tau ua tiav lossis ib nrab tshem tawm ntawm nephrotic syndrome ntawm 24 lub hlis. Cov txiaj ntsig sib xyaw no tau tshwm sim hauv 36 tus neeg mob (83.7 feem pua) hauv corticosteroid-cyclophosphamidepab pawg thiab 25 tus neeg mob (58.1 feem pua) hauvtacrolimus-rituximabpab pawg (tus txheeb ze txaus ntshai 1.44; 95 feem pua kev ntseeg siab lub sijhawm 1.08 txog 1.92). Kev ua kom tiav ntawm 24 lub hlis tshwm sim hauv 26 tus neeg mob (60 feem pua) hauv pawg corticosteroid-cyclophosphamide thiab 11 tus neeg mob (26 feem pua) hauvtacrolimus-rituximabpab pawg (2.36; 1.34 txog 4.16). Anti-PLA2R titers pom qhov txo qis hauv ob pawg tab sis qhov feem pua ntawm cov neeg mob tiv thaiv PLA2R-zoo uas ua tiav cov tshuaj tiv thaiv kab mob (depletion ntawm anti-PLA2R cov tshuaj tiv thaiv) tau nce ntau dua ntawm peb thiab rau lub hlis hauv corticosteroid-cyclophosphamidepawg (77 feem pua thiab 92 feem pua , feem), piv rau covtacrolimus-rituximabpawg (45 feem pua thiab 70 feem pua , feem). Relapses tshwm sim hauv ib tus neeg mob hauv corticosteroid-cyclophosphamidepab pawg, thiab peb tus neeg mob hauv lubtacrolimus-rituximabpab pawg. Cov xwm txheej tsis zoo tshwm sim zoo sib xws hauv ob pawg. Yog li, kev kho mob nrog corticosteroid- cyclophosphamide-induced remission nyob rau hauv cov neeg mob ntau dua.thawj membranous nephropathytshajtacrolimus-rituximab.

Raum International (2021) 99, 986–998;

j.kint.2020.10.014

cistanche can treat kidney disease improve renal function

cistanchekho tauraumkab mobtxhim kholub raum ua haujlwm

KEYWORDS:lub raum ua haujlwm, mob raum, kab mob raum kawg, mob raum raug mob, mob raum mob, thawj membranous nephropathy, rituximab, corticosteroids, cyclophosphamide

Copyright ª 2020, International Society of Nephrology. Tshaj tawm los ntawm Elsevier Inc. Qhov no yog ib tsab xov xwm qhib rau hauv qab daim ntawv tso cai CC BY-NC-ND

Primary membranous nephropathy(PMN) yog ib qho ntawm feem ntau ua rau nephrotic syndrome rau cov neeg laus.¹Hauv 70 feem pua -80 feem pua ntawm cov neeg mob, tus kab mob yog kho los ntawm autoantibodies tsom rau phospholipase A2 receptor (PLA2R) qhia hauv podocytes thiab 3 feem pua -5 feem pua los ntawm autoantibodies rau thrombospondin hom 1 domain-muaj 7A (THSD7A).^2–4Kev tshem tawm spontaneous tshwm sim hauv ib feem peb ntawm cov neeg mob,⁵thiab yog li ntawd lub sijhawm soj ntsuam tsawg kawg yog 6 lub hlis raug pom zoo.^6–8Hloov pauv, kwv yees li 50 feem pua ntawm cov neeg mob uas mob nephrotic syndrome nws thiaj li nce muskab mob raum kawg, thiab immunosuppressive kho yog pom zoo rau cov neeg mob no.

Kev tsis sib haum xeeb tshwm sim txog yam zoo tshaj plaws ntawm kev tiv thaiv kab mob. Xyoo 2012Kab mob raum: Txhim kho Ntiaj Teb Cov Tau Txais (KDIGO) cov lus qhia rau glomerulonephritis tau pom zoo rau 6- hli cyclic regimen ntawm kev hloov cov tshuaj alkylating (ib txwm cyclophosphamide) ntxiv raucorticosteroidsrau cov neeg mob uas muaj kev pheej hmoo ntawm kev loj hlob vim nws yog tib txoj cai uas tau pom tias muaj txiaj ntsig zoo hauv kev tiv thaivkab mob raum kawg. ^8–12Txawm li cas los xij, muab cov naj npawb tseem ceeb ntawm cov xwm txheej tsis zoo cuam tshuam nrog cov koob tshuaj ntawm cov tshuaj alkylating, cov kev kho mob tau qhia. Calcineurin inhibitors (ob leeg cyclosporine thiabtacrolimus) tau pom tias muaj txiaj ntsig hauv kev ua kom tshem tawm cov kab mob nephrotic hauv li 70 feem pua ntawm cov neeg mob.^13,14Txawm li cas los xij, qhov kev txwv tseem ceeb ntawm cov tshuaj no yog qhov siab ntawm kev rov qab los tom qab txiav tawm. Ib qho kev soj ntsuam kev tshawb nrhiav pom qhov txo qis ntawm qhov rov qab los thaumrituximabtau muab tshuaj thaum lub sij hawm tapering tawm cyclosporine los yogtacrolimus, ¹⁵thiab ib txoj kev tshawb nrhiav tau qhia txog kev txhawb nqa cov txiaj ntsig ntawm kev kho mob nrog cyclosporine ntxivrituximabnyob rau hauv cov neeg mob siab PMN.¹⁶

Immunosuppressive kho yog pom zoo raukab mob raum kawgthiabthawj membranous nephropathy.

Tsis ntev los no, qhov ua tau zoo ntawmrituximabmonotherapy tau txais kev saib xyuas zoo.¹⁷Ib koob tshuajrituximabtau pom zoo kom muaj txiaj ntsig rau induction ntawm remission nyob rau hauv kev soj ntsuam cohort,¹⁸txawm li cas los xij, hauv kev sim tshuaj tsis ntev los no, kev siv tshuaj ntau dua yuav tsum tau ua kom tau txais txiaj ntsig zoo.^19–21Tseeb, qhov superior efficiency ntawmrituximabpiv rau cyclosporine hauv MENTOR tsis ntev los no (Membranous nephropathyKev sim ntawmRituximab) txoj kev tshawb fawb tau ua tiav siv cov koob tshuaj tag nrho ntawm 4 grituximab.²⁰

Qhov kev xav tau ntawm kev sim mus rau lub taub hau piv rau 6- hli cyclic alternating kho nrogcorticosteroidsthiabcyclophosphamidenrog rau cov kev kho tshiab tshiab (calcineurin inhibitors,rituximab) tau ntxhov siab hauv KDIGO lub rooj sib tham tsis ntev los no.²²Peb tsim lub STARMEN (Kev kho mob sib txuas nrogTacrolimusthiabRituximabVersus AlternatingCorticosteroidsthiabCyclophosphamidenyob rau hauv PMN) kawm los sib piv cov cyclic alternating kev kho mob ntawmcorticosteroidsthiabcyclophosphamidenrog ib tug sequential kho ntawmtacrolimusthiabrituximabnyob rau hauv induction thiab txij nkawm ntawm nephrotic syndrome remission mus txog 24 lub hlis. Tsis tas li ntawd, peb tau kawm txog qhov tshwm sim ntawm qhov rov tshwm sim tom qab tshem tawm thiab lub luag haujlwm ntawm cov tshuaj tiv thaiv PLA2R autoantibodies rau kev kho mob.

figure 1 (2)

figure 1 (3)

TSEEM CEEB

Cov neeg mob

Txij thaum Lub Rau Hli 2014 txog Lub Rau Hli 2017, 130 tus neeg mob tau raug soj ntsuam rau kev tsim nyog, ntawm 44 (33 feem pua) raug tshem tawm los ntawm txoj kev tshawb no. Cov laj thawj tseem ceeb ntawm kev tshuaj ntsuam xyuas tsis ua raws li cov txheej txheem tsim nyog (21 tus neeg mob), tsis kam koom nrog hauv txoj kev tshawb no (14 tus neeg mob), thiab kev kuaj mob thib ob ntawm qhov ua rau.membranous nephropathy(9 tus neeg mob). Cov 86 cov neeg mob uas ua tau raws li cov txheej txheem tsim nyog tau raug muab tso rau hauvcorticosteroid-cyclophosphamidepab pawg (43 tus neeg mob) lossis covtacrolimus-rituximabpab pawg (43 tus neeg mob) (Daim duab 1). Raws li tau hais hauv Table 1, tsis muaj qhov sib txawv tseem ceeb ntawm cov pab pawg tau pom nyob rau hauv lub hauv paus. Cov qauv khaws cia hauv cov ntshav muaj nyob hauv 69 tus neeg mob, thiab cov tshuaj tiv thaiv PLA2R tau zoo hauv 53 (77 feem pua). Kev soj ntsuam rhiab heev tsis muaj qhov sib txawv ntawm cov hauv paus ntsiab lus ntawm kev tiv thaiv-PLA2R-zoo thiab tiv thaiv-PLA2R-cov neeg mob tsis zoo lossis ntawm cov neeg mob uas muaj lossis tsis muaj kev txiav txim siab tiv thaiv PLA2R ntawm lub hauv paus (Cov Lus Ntxiv S1 thiab S2). Ib tus neeg mob tau tiv thaiv THSD7A zoo. Lub raum biopsies tau ua 8 (ntau, 6-18) lub hlis ua ntej randomization. Xya caum-peb tus neeg mob (85 feem pua) muaj de novo PMN thiab 13 (15 feem pua) rov qab PMN (Table 1).

Table 1

Txhua tus neeg mob tau txais tsawg kawg yog 1 lub hlis ntawm kev pabcuam khomob. Ob tug neeg mob hauv lubcorticosteroid-cyclophosphamidepab pawg (4.6 feem pua) thiab 6 (13.9 feem pua) hauvtacrolimus-rituximabpab pawg tau txiav kev cuam tshuam (Daim duab 1). Qhov seem 41 nyob rau hauvcorticosteroid-cyclophosphamidepab pawg thiab 37 hauvtacrolimus-rituximabpab pawg) tau txais kev cuam tshuam tag nrho. Cov neeg mob muab rau lubcorticosteroid-cyclophosphamidepab pawg tau txais koob tshuaj nruab nrab ntawm qhov ncauj methylprednisolone ntawm {{0}}}.49 ± 0.05 mg / kg / hnub hauv lub hlis 1, 3, thiab 5, nrog rau tag nrho cov koob tshuaj ntawm 3.4±0.9 g. Tag nrho cov koob tshuaj methylprednisolone intravenous yog 8.2 ± 1.4 g. Tag nrho cov koob tshuaj ntawmcyclophosphamideyog 10 ± 3.5 g. Doses thiab ntshav theem ntawmtacrolimushauvtacrolimus-rituximabpab pawg tau nthuav tawm hauv Cov Lus Ntxiv S3. Peb tus neeg mob hauv pab pawg no tau txais koob thib ob ntawmrituximab(0.5 g hauv 2 tus neeg mob, 1 g hauv 1 tus neeg mob) ntawm lub hlis 12, 12, thiab 18, raws li, thiab 2 lwm tus tau txais koob tshuaj ntxiv ntawmtacrolimusdhau lub hlis 9.

Thaum lub sijhawm rov qab los tom qab qhov kawg ntawm qhov kev cuam tshuam, 5 tus neeg mob hauv txhua pab pawg tau hloov mus rau qhov kev cuam tshuam tsis zoo vim qhov tsis muaj txiaj ntsig ntawm kev kho mob. Hauvcorticosteroid-cyclophosphamidepab pawg, 2 cov neeg mob tau kho nrogrituximabthaum lub hli 14, 2 tus neeg mob tau txaistacrolimustxij lub hli 18, thiab 1 tus neeg mob cyclosporine los ntawm lub hli¹⁶. Hauvtacrolimus-rituximabpab pawg, 5 tus neeg mob tau txais 6- hli kev kho mob nrog corticosteroid thiabcyclophosphamideLub hli 12 (2 tus neeg mob), lub hli 14 (2 tus neeg mob), lossis lub hli 21 (1 tus neeg mob). Txhua tus neeg mob uas tau hloov mus rau qhov kev cuam tshuam tsis muaj kev kawm tau suav tias yog cov neeg tsis teb (Daim duab 1). Kev soj ntsuam tau ua tiav nyob rau hauv tag nrho ntawm 86 cov neeg mob cuv npe.

Thawj qhov tshwm sim Peb caug-rau tus neeg mob (83.7 feem pua) hauvcorticosteroid-cyclophosphamidepab pawg thiab 25 tus neeg mob (58.1 feem pua) hauvtacrolimus-rituximabpab pawg muaj qhov txiaj ntsig tseem ceeb ntawm kev ua tiav / ib nrab tso tawm ntawm 24 lub hlis (cov txheeb ze txaus ntshai [RR] 1.44, 95 feem pua kev ntseeg siab lub sijhawm [CI] 1.08 txog 1.92) (Table 2; Daim duab 2a). Kev txheeb xyuas ib tus txheej txheem tau lees paub qhov sib txawv tseem ceeb hauv cov txiaj ntsig tseem ceeb ntawm cov pab pawg: 35 ntawm 41 (85 feem pua) hauvcorticosteroid-cyclophosphamidepab pawg thiab 22 ntawm 37 (59 feem pua) hauvtacrolimus-rituximabpab pawg (RR 1.44, 95% CI 1.07 txog 1.93) (Table 2). Qhov sib txawv ntawm tus naj npawb ntawm cov neeg mob uas tau ua tiav lossis ib nrab tso tawm hauv ob pawg twb tseem ceeb nyob rau lub hli 3 thiab tau khaws cia thoob plaws txoj kev tshawb no (Table 2; Daim duab 2a).

Figure 2(2)

Figure 2(3)

Table 2

Raws li pom nyob rau hauv Table 3 thiab daim duab 2b, 26 cov neeg mob (60 feem pua) nyob rau hauv lubcorticosteroid-cyclophosphamidepab pawg tau ua tiav kev zam txim ntawm 24 lub hlis. Hauvtacrolimus-rituximabpab pawg, 11 tus neeg mob (26 feem pua) tau ua tiav qhov kev tso tawm tiav ntawm 24 lub hlis (RR 2.36, 95 feem pua CI 1.34 txog 4.16).

Table 3

Ib tug nyiam rau kev ua tau zoo dua ntawm covcorticosteroid-cyclophosphamideKev kho mob tau pom nyob thoob plaws cov pab pawg sib txawv uas tsis tau teev tseg los ntawm pawg thawj coj ntawm cov proteinuria, ntshav albumin, ntshav creatinine, anti-PLA2R qib. thiab hnub nyoog, txawm hais tias tsis muaj qhov sib txawv hauv cov poj niam cov neeg mob (Cov duab ntxiv S1). Thaum cov yam ntxwv tseem ceeb ntawm cov neeg mob tau muab piv rau cov neeg uas ua tiav / ib nrab kev tso tawm thiab cov uas tsis muaj lus teb, feem ntau ntawm cov txiv neej (80 feem pua vs. 57 feem pua) thiab cov proteinuria ntau dua tau pom ntawm cov neeg tsis teb (Sab Ntxiv Table S4).

acteoside in cistanche

Cov txiaj ntsig thib ob

Proteinuria poob los ntawm qhov nruab nrab ntawm 7.4 g / 24 h (interquartile ntau 4.8-11.3) ntawm lub hauv paus rau 0.35 g / 24 h ({10}}.2-9) ntawm 24 lub hlis hauvcorticosteroid-cyclophosphamidepab pawg thiab los ntawm 7.4 g / 24 h (6.7–11.6) ntawm lub hauv paus mus rau 1 g / 24 h (0.3–3.3) ntawm 24 lub hlis hauvtacrolimus-rituximabpab pawg (nruab nrab ntawm pawg sib txawv P ¼ 0.005) (Daim duab 3a; Cov lus ntxiv S5). Serum albumin nce los ntawm qhov nruab nrab 2.6 ± 0.1 g / dl ntawm lub hauv paus mus rau 4 ± 0.1 g / dl ntawm 24 lub hlis hauv corticosteroid-cyclophosphamidepab pawg thiab los ntawm 2.6 ± 0.1 g/dl ntawm lub hauv paus mus rau 3.9±0.1 g/dl ntawm 24 lub hlis hauvtacrolimus-rituximabpab pawg (nruab nrab ntawm pawg sib txawv P ¼ 0.2) (Daim duab 3b; Cov lus ntxiv S5). Muaj qhov tsis tseem ceeb rau qhov muaj txiaj ntsig ntau dua ntawm kwv yees glomerular filtration rate (eGFR) hauvcorticosteroidcyclophosphamidepab pawg dua hauvtacrolimus-rituximabpab pawg thoob plaws qhov kev soj ntsuam (Daim duab 3c; Cov lus ntxiv S6). Thaum 24 lub hlis, tus lej ntawm cov neeg mob uas muaj ntau dua lossis sib npaug li 50 feem pua nce ntawm cov hauv paus ntshav creatinine yog 1 (2 feem pua) hauvcorticosteroid-cyclophosphamidepab pawg thiab 5 (12 feem pua) hauv covtacrolimus-rituximabpab pawg (P ¼ 0.2). Tus naj npawb ntawm cov neeg mob uas khaws cialub raum ua haujlwm(eGFR Ntau dua lossis sib npaug li 45 ml / min ib 1.73 m2) ntawm 24 lub hlis yog 40 (93 feem pua) hauvcorticosteroid-cyclophosphamidepab pawg thiab 37 (86 feem pua) hauv covtacrolimus-rituximabpab pawg (P ¼ 0.48). Tus neeg mob nkaus xwb uas tsimkab mob raum kawgyog ib tug txiv neej muaj hnub nyoog 73- xyoo uas tau raug xa mus raucorticosteroid-cyclophosphamidepab pawg. Peb lub hlis tom qab ua tiav kev kho mob nws raug cais tawm ntawm txoj kev tshawb no vim tias muaj proteinuria tsis tu ncua thiab poob qis.lub raum ua haujlwmthiab hloov mus raurituximab(2 koob tshuaj 1 g, 15 hnub sib nrug). Tsis muaj cov lus teb tau pom, thiab kev lim ntshav ntev tau pib 16 lub hlis tom qab randomization.

Figure 3（2）

Figure 3（3）

Anti-PLA2R qib tau pom qhov txo qis hauv ob pawg (Table 4; Daim duab 3a). Qhov feem pua ntawm cov tshuaj tiv thaiv PLA2R - cov neeg mob zoo uas ua tiav cov tshuaj tiv thaiv kab mob hauv 3 thiab 6 lub hlis tau nce siab dua hauvcorticosteroidcyclophosphamidepab pawg (77 feem pua thiab 92 feem pua , feem) dua li hauvtacrolimus-rituximabpab pawg (45 feem pua thiab 70 feem pua , feem) (Table 4). Cov neeg mob feem ntau (80 feem pua ) uas tau ua tiav cov tshuaj tiv thaiv kab mob hauv lub sijhawm kawm tau nthuav tawm kev tshem tawm ntawm nephrotic syndrome ntawm 24 lub hlis. Immunologic teb ntawm 3 lub hlis (P ¼ 0.036) thiab 6 lub hlis (P ¼ 0.005) tau cuam tshuam nrog kev tso tawm ntawm 24 lub hlis. Cov neeg mob uas tsis teb cov lus pom tau qeeb qeeb ntawm cov tshuaj tiv thaiv PLA2R thiab qhov feem pua ntawm cov tshuaj tiv thaiv kab mob, piv nrog rau cov neeg mob uas tau ua tiav lossis ib feem ntawm kev tso tawm ntawm nephrotic syndrome (Table Ntxiv S7).

Table 4

Ib tug ntawm 36 tus neeg mob (2.7 feem pua) nyob rau hauvcorticosteroidcyclophosphamidepab pawg, thiab 3 ntawm 25 tus neeg mob (12 feem pua) hauvtacrolimus-rituximabpab pawg uas tau ua tiav ib nrab kev zam txim tau nthuav tawm qhov rov qab los (Sab Ntxiv Table S8). Lub 3 relapses nyob rau hauv lubtacrolimus-rituximabpab pawg tau tshwm sim thaum lub hli 12, 3 lub hlis tom qabtacrolimuskev txiav tawm. Ob ntawm lawv tau tshwm sim hauv cov neeg mob anti-PLA2R-zoo uas tau mus txog qhov kev tiv thaiv kab mob hauv lub hli 6 thiab tsis tau nrog rov tshwm sim ntawm cov tshuaj tiv thaiv PLA2R. Qhov seem rov qab tshwm sim hauv tus neeg mob uas cov tshuaj tiv thaiv PLA2R tsis tau ntsuas ntawm lub hauv paus.Tacrolimustau rov pib dua hauv 2 tus neeg mob thiab lwm tus tau kho nrogrituximab. Relapse nyob rau hauvcorticosteroid-cyclophosphamidepawg tau tshwm sim nyob rau lub hli 9 nyob rau hauv ib tug anti-PLA2R-tus neeg mob zoo uas tau mus txog immunologic teb nyob rau lub hli 3. Nyob rau hauv cov ntaub ntawv no, tus relapse tau nrog ib tug rov tshwm sim ntawm anti-PLA2R tshuaj tiv thaiv, thiab tus neeg mob tau kho nrog.tacrolimus.

Cov xwm txheej tsis zoo Txhua tus neeg mob tsuas yog 6 (1 los ntawmcorticosteroid-cyclophosphamidepab pawg thiab 5 ntawm covtacrolimus-rituximabpawg) muaj tsawg kawg yog 1 qhov tshwm sim tsis zoo (Table 5). Cov xwm txheej tsis zoo feem ntau yog qis (345, 84 feem pua) lossis nruab nrab (56, 13 feem pua) qhov hnyav, tab sis¹⁷(4 feem pua) mob hnyav. Muaj ntau cov xwm txheej tsis zoo thiab cov xwm txheej tsis zoo rau tus neeg mobcorticosteroid-cyclophosphamidepab pawg dua hauvtacrolimus-rituximabpab pawg (P ¼ 0.04). Ntau tus neeg mob hauv corticosteroidcyclophosphamidepab pawg muaj leukopenia thiab Cushing syndrome, thaummob raum raug mob, hyperkalemia, raws plab, thiab distal tremor yog ntau dua nyob rau hauv lubtacrolimus-rituximabpab pawg. Muaj ib qho kev sib koom ua ke tseem ceeb ntawm kev muaj leukopenia thiab kev loj hlob ntawm kev kis kab mob, ob qho tib si hauv tag nrho cov kev sim thiab hauv txhua pab pawg kho mob (P < 0.0001="" rau="" tag="" nrho="" cov="" pab="" pawg="">cyclophosphamidepab pawg, P ¼ 0.041 rau tacrolimus/rituximabpab pawg). Feem ntau cov xwm txheej tsis zoo tshwm sim nyob rau thawj 9 lub hlis ntawm kev sim (304 ntawm 409, 74 feem pua), tab sis tsuas yog 5 ntawm 17 qhov xwm txheej tsis zoo tshwm sim nyob rau lub sijhawm no.

Table 5（1）

Table 5（2）

Tsis muaj qhov sib txawv tseem ceeb hauv qhov sib txawv ntawm cov xwm txheej loj ntawm cov pab pawg. Tsuas yog qhov mob hnyavmob raum raug mobtshwm sim hauvtacrolimus-rituximabpab pawg, thaum 4 ntawm 5 tus kab mob hnyav tshwm sim hauvcorticosteroid-cyclophosphamidepab pawg. Peb kis mob qog noj ntshav tau tshaj tawm, txawm hais tias tsis muaj leej twg tau suav tias muaj feem cuam tshuam nrog kev kho mob tau txais. Ob tug mob qog noj ntshav tau tshwm sim nyob rau hauvcorticosteroidcyclophosphamidepab pawg (gastric adenocarcinoma thiab mis carcinoma, kuaj pom ntawm 12 thiab 11 lub hlis, feem) thiab 1 hauvtacrolimus-rituximabpab pawg (cov kab mob hauv lub qhov quav, kuaj pom ntawm 1 lub hlis). Anti-PLA2R yog qhov zoo ntawm lub hauv paus hauv 3 cov neeg mob qog noj ntshav. Thaum kuaj mob qog, 2 tus neeg mob hauv lubcorticosteroid-cyclophosphamidepab pawg tau nyob rau hauv kev kho mob.

Cistanche- primary membranous nephropathy