脓毒症相关的急性肾损伤(acute kidney injury,SA-AKI)是脓毒症的并发症之一,死亡率高.脓毒症可引发全身炎症反应综合征,而脂多糖(lipopolysaccharide,LPS)亦可引起全身炎症反应,而Toll样受体4(Toll-like receptor 4,TLR4)是参与LPS识别和下游炎性信号启动的关键受体.LPS进入宿主体内会被LPS结合蛋白(recombinant lipopolysaccharide binding protein,LBP)识别,经由白细胞分化抗原CD14传递,与TLR4-MD2复合物结合,激活TLR4相关的信号传导通路,引起大量炎症因子释放,引起一系列的机体机能紊乱,短时间对肾脏造成损伤.目前,SA-AKI治疗仍以对症治疗为主,缺乏特异性的靶向治疗药物.了解LPS如何激活TLR4相关通路有助于寻求新的治疗靶点,可为新药物研发提供新思路.

继发性甲状旁腺功能亢进症（SHPT）是慢性肾脏病（CKD）患者最常见的并发症之一,以甲状旁腺激素（PTH）水平升高和甲状旁腺腺体增生为主要表现 [1] 。随着透析龄延长,SHPT的发病率越高,有研究显示长期进行透析的患者出现SHPT的概率超过50% [2] 。PTH是一种尿毒症毒素,其受体PTH-1广泛分布于骨骼、肾脏、皮肤、胰腺、心脏及循环系统等 [3] 。目前研究表明,PTH与其受体结合,不仅可导致肾性骨病、瘙痒、神经系统损害等,

目的 分析心脏瓣膜钙化(cardiac valve calcification,CVC)和颈动脉粥样硬化(carotid athero-sclerosis,CAS)对维持性腹膜透析患者预后的影响,并探讨联合2个指标预测腹膜透析患者全因死亡和心血管死亡的价值.方法 2015年7-12月在南京医科大学附属无锡人民医院腹膜透析中心行持续性非卧床腹膜透析(CAPD)或日间非卧床腹膜透析(DAPD)治疗≥3个月的腹膜透析患者,收集患者一般临床资料、实验室检查结果,并行心脏超声和颈动脉超声检查.将CVC、CAS均作为危险标记,将患者分为3组:0、1、2个危险标记组.随访所有患者至死亡、退出腹膜透析或至研究终止(2020年6月30日).通过Kaplan-Meier法分析3组患者全因死亡和心血管死亡.Cox比例风险模型分析0、1和2个危险标记对患者全因死亡和心血管死亡的预测作用.结果 入选166例腹膜透析患者,46(27.7％)例存在CVC,88(53.0％)例存在CAS.70例患者无危险标记,58例存在1个危险标记(CVC或CAS),38例存在2个危险标记(CVC和CAS).至研究终止,34例患者死亡,其中21例死于心血管疾病.Kaplan-Meier生存分析提示3组间全因死亡及心血管死亡差异具有统计学意义(P<0.001).Cox回归分析显示与无危险标记的患者相比,2和1个危险标记的患者的全因死亡HR分别为8.011(95％CI:2.493～25.741,P=0.001)和2.711(95％CI:0.820～8.961,P=0.102),心血管死亡的HR分别为6.734(95％CI:1.643～27.610,P=0.008)和1.694(95％CI:0.385～7.460,P=0.486).与任何1个危险标记相比,联合使用2个危险标记预测全因死亡和心血管死亡的受试者曲线下面积(AUC)均增大.结论 CVC和CAS是影响腹膜透析患者危险因素,联合2个指标可更好地预测腹透患者的预后.

目的 探讨成纤维细胞生长因子23(fibroblast growth factor-23,FGF-23)水平在终末期肾病(end stage renal disease,ESRD)患者桡动脉钙化(radial artery calcification,RAC)与自体动静脉内瘘(arteriovenous fistula,AVF)失功中的预测价值.方法 收集212例在南京医科大学附属无锡市人民医院行AVF手术的ESRD患者的临床资料,采用ELISA检测患者术前血清FGF-23水平.采用HE染色法对桡动脉血管进行钙化染色以评估RAC程度.据随访期间临床及影像学资料将患者分为AVF失功及AVF通畅组.比较FGF-23水平在不同分组中的差异及预测作用.结果 212例患者中有57.8％发生RAC(123/212).当 cut-off 值取 FGF-23＞488.5ng/ml 时,FGF-23预测 RAC 的敏感性为0.797,特异性为0.921;当cut-off值取FGF-23＞490.9ng/ml时,预测AVF失功的敏感性为0.757,特异性为0.560.结论 ESRD患者RAC的发生率高,FGF-23可能是预测RAC及AVF失功的理想标志物.

目的:探讨miR-101靶向雷帕霉素靶蛋白(mTOR)信号通路调控足细胞自噬在小鼠糖尿病肾病发病中的作用.方法:将成年雄性C57 BL/6小鼠分为对照组、模型组和雷帕霉素组,每组10只.模型组和雷帕霉素组小鼠连续腹腔注射链脲佐菌素(55 mg·kg-1)5 d,对照组腹腔注射等量生理盐水.腹腔注射链脲佐菌素后1周,雷帕霉素组小鼠腹腔注射雷帕霉素(2 mg·kg-1),对照组和模型组小鼠腹腔注射等量生理盐水,隔天1次,连续12周后对小鼠肾脏组织行PAS染色,用透射电镜观察足细胞损伤及自噬情况,同时检测肾组织中miR-101、Nephrin、LC3Ⅰ、LC3Ⅱ、mTOR和AMPK mRNA的表达.结果:对照组小鼠肾脏和足细胞足突正常,模型组小鼠肾脏局部可见球囊融合;与对照组相比模型组小鼠肾脏系膜基质明显增多,基底膜明显增厚,足突明显增宽、融合,自噬体明显减少;与模型组相比,雷帕霉素组小鼠肾脏系膜基质明显减少,基底膜增厚和足突融合明显减轻,自噬体明显增加.与对照组相比,模型组和雷帕霉素组小鼠肾脏系膜基质面积增大、mTOR mRNA表达水平明显升高,Nephrin、LC3Ⅰ、LC3Ⅱ、miR-101和AMPK mRNA表达水平明显降低(P<0.05);与模型组相比,雷帕霉素组小鼠mTOR mRNA表达水平明显降低,Nephrin、LC3Ⅰ、LC3Ⅱ、miR-101和AMPK mRNA表达水平明显升高(P<0.05).结论:miR-101通过靶向调控mTOR信号通路促进糖尿病肾病小鼠足细胞自噬,为糖尿病肾病的治疗提供了新方向.

目的:探讨早期干预型护理对缺血缺氧性脑病(HIE)新生儿智力发育、运动发育及体格发育的影响.方法:选择2017年4月—2018年3月本院收治的新生儿缺血缺氧性脑病患儿76例,按随机数表法分为对照组和观察组,每组38例,对照组给予常规护理,观察组联合实施早期干预型护理,对比两组患儿的智力发育、运动发育及体格发育.结果:护理后3、6个月,两组智力发育、运动发育对比,差异无统计学意义(P>0.05);护理后9、12个月,观察组MDI评分、PDI评分高于对照组,差异有统计学意义(P<0.05);护理12个月后,两组体重、身长、头围及胸围对比,差异无统计学意义(P>0.05).结论:对HIE患儿采用早期干预型护理有助于刺激患儿的感官和运动神经,长期实施有利于促进患儿的智力和运动发育.

目的 系统评价白细胞介素-10(interleukin-10,IL-10)基因-1082A/G多态性与糖尿病肾病(diabetic nephrop-athy,DN)易感性之间的关系.方法 检索建库以来至2019年6月间与IL-10基因1082A/G及DN发病风险相关的病例对照研究,使用纽卡斯尔渥太华(Newcastle-Ottawa Scale,NOS)标准对纳入文献进行质量评价.采用STATA12.0软件进行统计分析,选择发病风险比值比(odds ratio,OR)及95％置信区间(confidence interval,CI)为效应指标.结果 本研究共纳入10项研究,包含DN患者1759例,单纯糖尿病(diabetes mellitus,DM)患者1525例,健康对照(heahy control,HC)者2209例.DN组与单纯DM组比较,IL-10基因-1082A/G多态性在各遗传模型上差异均无统计学意义(P＞0.05).DN组与健康人群比较,IL-10基因-1082A/G多态性在纯合子模型下与DN呈明显相关性(GG vs AA:OR=0.577,P＜0.05).将地区进行亚组分析发现,亚洲人群中IL-10基因-1082A/G多态性在除杂合子模型外的其他遗传模型中差异均有统计学意义(G vs A:OR =0.589,P=0.031;GGvsAA:OR=0.349,P=0.000;GG vs GA+AA:OR=0.588,P=0.015;GG+GA vs AA:OR=0.629,P=0.000).结论 IL-10基因-1082A/G多态性与DN发病相关,亚洲人群中G等位基因、GG基因型是DN发病的保护因素.

目的 探讨终末期肾衰(ESRD)拟透析患者腹主动脉钙化与胰岛素抵抗、微炎症状态、成纤维细胞生长因子23(FGF23)/klotho轴的关系.方法 分析60例ESRD拟行维持性透析患者(ESRD组)的临床资料,检测胰岛素抵抗指数(HOMA-IR),血清微炎症状态指标TGF-β、IL-6,血清FGF23、可溶性klotho蛋白(sklotho)水平,并与健康对照组进行比较.观察ESRD患者腹主动脉钙化的发生情况,比较发生腹主动脉钙化与未发生腹主动脉钙化患者的临床资料,采用Logistic回归分析发生腹主动脉钙化的危险因素.结果 与健康对照组比较,ESRD组HOMA-IR、血清FGF23升高,sklotho降低(P<0.05或<0.01).ESRD组中,35例发生腹主动脉钙化,25例未发生腹主动脉钙化.与无钙化患者比较,钙化患者HOMA-IR及血清FGF23、TC升高,sklotho、Alb降低(P<0.05或<0.01).Logistic回归分析显示,血清FGF23(OR=0.993、P=0.032)、sklotho(OR=1.006、P=0.009)是腹主动脉钙化的独立危险因素.结论 ESRD拟透析患者体内存在胰岛素抵抗、微炎症状态及FGF23/klotho轴异常,血清FGF23升高和sklotho降低是腹主动脉钙化的独立危险因素.FGF23/klotho轴可能与胰岛素抵抗、微炎症状态相互作用,共同参与ESRD患者腹主动脉钙化的发生.

膜性肾病是目前成年肾病综合征的主要原因,以肾小球毛细血管基膜均匀一致增厚、弥漫性上皮下免疫复合物沉积为病理特点,临床以大量蛋白尿或肾病综合征为主要表现.近年来,新的足细胞抗原的发现及其研究,尤其是磷脂酶A2受体及重要的补充抗原血小板反应蛋白7A结构域等新型抗原的发现以及对下游补体激活途径的研究,加深了对特发性膜性肾病(IMN)相关机制、疗效分析及预后判断等的认识,但目前IMN的发病机制及临床诊疗方案尚不明确.

目的 调查腹膜透析患者心脏瓣膜钙化及颈动脉粥样硬化(cAS)的发生率,探讨两者的相关性及影响因素.方法 选取南京医科大学附属无锡人民医院腹膜透析中心行规律腹膜透析≥3个月的患者166例,收集患者一般临床资料、实验室检查资料,并行心脏超声和颈动脉超声检查.结果 心脏瓣膜钙化组46例(27.7％),无心脏瓣膜钙化组120例(72.3％),心脏瓣膜钙化组患者25-羟维生素D水平为(18.32±10.64)ng/ml,无心脏瓣膜钙化组患者25-羟维生素D水平为(19.17±10.81)ng/ml,两组比较差异无统计学意义(P>0.05).两组比较,年龄、透析时间、收缩压、血清白蛋白、hs-cRP、IL-6差异有统计学意义(P<0.05).心脏瓣膜钙化组合并cAS的患者38例(82.6％),无心脏瓣膜钙化组的cAS患者50例(41.7％),两者比较差异有统计学意义(P<0.05).既有心脏瓣膜钙化又有cAS的患者38例(A组),既无心脏瓣膜钙化又无cAS的患者70例(B组),两组间年龄、透析龄、收缩压、舒张压、血清白蛋白、LDL-c、hs-cRP、IL-6、iPTH比较,差异有统计学意义(P<0.05).二分类Logistic回归分析显示,年龄、收缩压与hs-cRP、IL-6为心脏瓣膜钙化的危险因素(P<0.05).年龄、透析龄、收缩压、hs-cRP、IL-6、吸烟为同时患心脏瓣膜钙化合并cAS的危险因素(P<0.05).结论腹膜透析患者心脏瓣膜钙化和cAS常常伴发,心脏瓣膜钙化和/或cAS与患者年龄、血压、炎症相关.

目的 探讨不同治疗方法对中重度肾功能减退的IgA肾病患者的疗效及预后情况.方法回顾性分析2011年1月至2017年7月在本院经肾活检确诊为原发性IgA肾病510例,选取中重度肾功能减退的患者,根据不同的治疗方法分成一般治疗组、单激素组、激素联合免疫抑制剂组(后简称免疫抑制组),比较三组间疗效与预后.结果三组12个月的累积完全缓解率分别为24.4％、28.8％、17.6％,无明显统计学差异(P>0.05);24 h尿蛋白定量与完全缓解率明显相关(P﹤0.05);24 h尿蛋白定量、肌酐水平与肾脏预后明显相关(P﹤0.05).结论中重度肾功能减退的IgA肾病经一般治疗、单激素治疗与激素联合免疫抑制剂治疗后12个月内疗效持平,监测24 h尿蛋白定量与肌酐水平对于评估患者临床疗效与肾脏预后具有明确价值.

目的 统计学分析肾动脉与脾动脉阻力指数(RI)以及两者的差值△RI与糖尿病肾病(DN)的相关性,探讨3个参数评估DN的可行性与可靠性.方法 257例DN患者纳入本次研究,测量每位患者的左肾肾动脉RI及脾动脉RI,并计算两者的差值△RI;同时测量颈动脉内膜厚度,收集心率、收缩压及舒张压,计算糖尿病肾病组患者的肾小球滤过率(eGFR).采用Spearman检验计算相关系数,多元线性回归方程分析肾动脉RI、脾动脉RI及△RI的独立预测因子.结果 Spearman检验显示肾动脉RI值和脾动脉RI值与年龄、脉压、颈动脉内膜厚度呈正相关(均P<0.01);与心率、eGFR呈负相关.△RI只与eGFR呈负相关.多元线性回归结果显示:肾动脉RI值与年龄、脉压和eGFR独立相关;脾动脉RI值与年龄、心率及脉压独立相关;△RI与eGFR独立相关,而与颈动脉内膜厚度、年龄、心率和脉压无相关性.结论 肾动脉RI与肾动脉与脾动脉RI差值△RI都可以反映老年人糖尿病肾病损害情况,其中△RI因不与肾外因素相关,可靠性更高.

Objectives To observe the levels of 25-hydroxy vitamin D [25(OH)D] in peritoneal dialysis patients and to investigate its influencing factors.Methods This cross-sectional study was carried out in peritoneal dialysis patients who were regularly followed up in our hospital from July 2015 to October 2015.One hundred cases in our hospital physical examination center line of physical health in the same period were selected as healthy controls.The levels of 25(OH)D were tested by enzyme-linked immunosorbent assay (ELISA).According to the K/DOQI guidelines standards, all patients were divided into vitamin D normal group, insufficient group and deficiency group.The differences of demography clinical and laboratory data between groups of patients and healthy controls, and the influencing factors of 25 hydroxy vitamin D were analyzed.Results One hundred and ten patients were enrolled in this study, 25 (OH) D level (23.27±10.22) ng/mL was significantly lower than the 100 healthy controls (34.82±9.58)ng/mL, (P<0.0001).Of these patients, 22 cases(20%) were considered 25(OH)D normal ,67 cases(60.9%) were insufficient and 21 cases (19.1%) were deficiency.Most of the peritoneal dialysis patients lacked of 25 (OH) D.The percentage of 25 (OH) D levels in female peritoneal dialysis patients was 31.91%, significantly higher than male (9.52%).Hb and Alb in 25 (OH) D deficiency group were significantly lower than normal group.TC and LDLC in 25 (OH) D deficiency group were significantly higher than normal group (P<0.05).Compared with insufficient group, Hb and LDLC in 25 (OH) D deficiency group were significantly lower (P< 0.05).25 (OH) D level was positively correlated with Alb (r=0.2883, P<0.0001), and negatively correlated with P (r=0.5156,P<0.0001),TG(r=0.2254, P=0.2254),LDLC(r=0.3004, P=0.3004).Conclusions Peritoneal dialysis patients generally have vitamin D deficiency.25 (OH) D levels are positively correlated with Alb, and negatively correlated with P, TG and LDLC.Which suggests an appropriate supplemental vitamin D for peritoneal dialysis patients with a serious lack of vitamin D.

目的:通过Meta分析方法评估利妥昔单抗治疗成人特发性膜性肾病的临床疗效和安全性.方法:系统检索相关数据库,检索从建库至2016年5月期间发表的利妥昔单抗治疗特发性膜性肾病的英文文献,获取的研究数据合并采用Comprehensive meta analysis软件.结果:共检索到166篇文献,最终纳入17篇文献,Meta分析结果显示,利妥昔单抗治疗特发性膜性肾病并随访超过12个月,26.4％(20.2 ～ 33.6％)患者达完全缓解,40.8％(33.4％～ 48.6％)达部分缓解,总缓解率65.7％ (61.3 ～ 69.9).大多数患者对利妥昔单抗能耐受.结论:利妥昔单抗能显著降低特发性膜性肾病患者蛋白尿,但仍需更大样本、长期随访RCT研究来进一步评估.

Objective To investigate the value of urine liver?type fatty acid?binding proteins(L?FABP) for early diagnosis and progress predicting of acute kidney injury(AKI)after lung transplantation. Methods Urine L?FABP and Scr blood samples in perioperative periods of 119 lung transplant recipients (hospitalized between 2013?2014)were involved in the research. Patients were divided into AKI group and non?AKI group according to KDIGO. Changes in urine L?FABP and Scr of two groups at various time points were recorded. Results Of 119 patients,57 developed AKI after surgery. Urine L?FABP from 0 h to 48 h in the two groups increased significantly, and the difference at 6 h to 48 h between the two groups is significant. In terms of diagnostic value,ROC area of urine L?FABP at 6h is 0.818. When 2254.52 ng/mg Cr was taken as diagnostic dividing line ,sensitivity and specificity was 0.782 and 0.814. In predicting AKI progression ,AUC below AUC of urine L?FABP 0.852. When 4313.17 ng/mgCr was taken as diagnostic dividing line ,sensitivity and specificity was 0.867 and 0.700. Conclusion Urinary L?FABP appears to be a sensitive and specific marker of AKI in lung transplant recipients ,could be a biological marker in the early diagnosis and progression tendency of AKI.

目的:观察高通量血液透析(HFHD)对终末期肾衰(ESRD)患者成纤维细胞生长因子23(FGF23)水平及钙磷代谢紊乱、动脉硬化和心脏功能的影响,进一步明确HFHD在减少ESRD并发症上的优势.方法:回顾性分析在我院透析治疗的ESRD患者的临床资料,根据透析方式分为高通量组(20例)和低通量组(20例),记录两组患者透析前及规律透析2、4、6个月后FGF23水平、血清学指标的变化和透析前、规律透析6个月后颈动脉内膜中层厚度(cIMT)、左心室射血分数(LVEF),分析影响ESRD患者FGF23水平的相关因素及不同透析方式对ESRD患者血清学指标、动脉硬化、心脏功能等的影响.结果:透析前两组性别、年龄、基础疾病、营养状况和药物使用以及治疗前血红蛋白(Hb)、白蛋白(ALB)、估算肾小球滤过率(eGFR)、血清Ca2+、p3-、甲状旁腺激素(PTH)、FGF-23水平比较,差异均无统计学意义(P＞0.05).高通量组血清p3-在治疗2、4、6个月时显著低于低通量组,LDLC在治疗4、6个月时与低通量组相比显著下降,Hb、HDLC在治疗6个月时较低通量组显著升高,而TG、PTH、FGF23在治疗6个月时较低通量组显著降低.两组透析6个月后的LVEF较透析前均有上升,但差异无统计学意义,两组间比较差异也无统计学意义.高通量组透析6个月后的cIMT较低通量组显著下降,差异有统计学意义(P＜0.05).治疗6个月后,FGF23与透析时间、Hb、血Ca2+呈负相关,与TG、血磷、PTH、cIMT呈正相关,与是否为HFHD呈负相关,与白蛋白、HDLC、LDLC、LVEF、KT/V、URR无显著相关.结论:对ESRD患者,HFHD可以更好地清除FGF23、纠正贫血和钙磷代谢紊乱、改善心脏功能.

目的 研究持续质量改进(CQI)模式对腹膜透析(PD)患者的液体平衡的影响.方法 选取2014年4-10月在本院肾内科行腹膜透析的120例患者作为研究对象,随机分为研究组和对照组各60例.研究组患者实施CQI管理模式,同时给予常规治疗和一般腹膜透析宣教,对照组患者仅给予常规治疗和一般腹膜透析宣教.6个月后对患者进行液体平衡管理的效果评价,包括血压、心率、胸片中的心胸比、血清N端前脑钠肽(NT-proBNP)水平以及外周有无浮肿等.结果 干预后,接受持续质量改进组护理的研究组患者收缩压、舒张压、心率、心胸比和NT-proBNP等临床指标,均低于自身干预前及对照组患者,差异有统计学意义(P＜0.01).研究组患者6例出现浮肿症状,显著低于对照组患者15例出现浮肿症状,差异有统计学意义(X2=4.675,P=0.031).结论 运用持续质量改进模式能有效改善维持性腹透患者的液体平衡管理.

Objective To investigate the relationship between hyperuricemia and metabolic syndrome in non‐diabetic patients undergoing peritoneal dialysis .Methods Serum level of uric acid was detected in 97 non‐diabetic patients undergoing regular peritoneal dialysis .Metabolic syndrome was diagnosed according to adjusted US National Cholesterol Education Program Adult Treatment Panel Ⅲ criteria .The risk factors for metabolic syndrome were analyzed using multivariate logistic regression analysis .Results The incidence of metabolic syndrome in the 97 patients was 45.4% .The incidence of metabolic syndrome was higher in the patients with hyperuricemia than that in those without hyperuricemia (χ2 = 3.950 ,P<0 .05) .Multivariate logistic regression analysis showed that serum uric acid(OR=2.142) ,body mass index(OR=1.498) ,triglyceride(OR=6.074) ,high‐density lipoprotein(OR= 0.039) ,and fasting blood glucose (OR = 2.384) were the independent influence factors for metabolic syndrome(P<0 .05) .Conclusion Non‐diabetic patients undergoing peritoneal dialysis exist a higher incidence of metabolic syndrome ,in whom hyperuricemia is an independent risk factor for metabolic syndrome .

Objective To research on the effect of atorvastatin on the Peritoneal fibrosis by detecting the IL -6、CA125 of Di-alysate with enzyme -labeled immunosorbent assay(ELISA).Method Fifty patients were divided into two groups to receive ator-vastatin 20 mg daily or Placebo for three months,then stop taking the medication for one month,And then cross taking these two drugs three months.Results The level of the CA125 in patients was improved by atorvastatin,the level of the IL -6 was declined (P <0.05).Conclusion The peritoneal fibrosis of the peritoneal dialysis patients is improved by atorvastatin.

Objective To analyze the different efficacies of MMF combined with prednisone for progressive IgA nephropathy with renal impairment and investigate the clinicopathological features that can be the predictive markers of the efficacies. Methods 42 patients with biopsy-proven primary IgA nephropathy treated by MMF combined with prednisone in Wuxi People's Hospital from February 2010 to June 2013 were enrolled in this retrospective analysis, and they also had charac-teristics of progressive IgA nephropathy accompanied by renal dysfunction. Results Of the 42 cases enrolled in study, men (21 cases) accounted for 61.9%, CKD3-4 patients accounted for 74.6%, with an average eGFR(50.29 ± 19.04)mL/min.1.73㎡and an average proteinuria(3.15 ± 1.73)g/d. All the 42 cases(100.0%) were treated with MMF combined with prednisone. The complete remission (CR), partial remission (PR) and no remission (NR) rate was 50.0%(21 cases), 35.6%(15 cases) and 14.3%(6 cases) respectively. The treatment efficiency was 85.6%. Compared to the responders (CR and PR groups), non-re-sponders(NR group) got higher baseline proteinuria(P<0.01) and lower serum albumin(P<0.05). Among the three groups at renal biopsy, NR group showed the highest serum creatinine(P<0.05) and lowest eGFR(P<0.05). Besides, renal tubular atro-phy and interstitial fibrosis appeared much severer in NR group(P<0.01), of them cellular crescents performance was rarer to be seen (P<0.01). Both univariate and multivariate COX regression analysis showed that proteinuria>3.5g/d, eGFR<30mL/min﹒1.73m2, severe renal tubular atrophy were independent risk factors for poor effects. Cellular crescents was an indepen-dent predictor of satisfactory effect(P<0.001). Adverse effects were more usually seen when there was poor therapy effect(P<0.05). Conclusion MMF combined with prednisone for progressive IgA nephropathy with renal impairment got good effect and safety. Urine protein >3.5g/d, eGFR<30mL/min﹒1.73m2, severe chronic damage of renal tubular were independent risk factors of poor curative effect. Cellular crescent performance was an independent predictor of good curative effect.