Sequential Treatment with Syndrome Differentiation on Children's Refractory Nephrotic Syndrome with Yiqi Huayu Qingre Prescription / 中国实验方剂学杂志

ObjectiveTo evaluate the clinical efficacy of sequential syndrome differentiation of Yiqi Huayu Qingre prescription （YHQ） in the treatment of refractory nephrotic syndrome in children. MethodA total of 112 children with refractory nephrotic syndrome were randomly divided into an observation group （57 cases） and a control group（55 cases）. The children in the control group were treated with prednisone tablets combined with tacrolimus，and those in the observation group were treated with YHQ by sequential syndrome differentiation on the basis of the control group. The total effective rates of the two groups after treatment were observed. The 24-hour urinary total protein（24 h UTP），plasma albumin（ALB），cholesterol（CHO），triglycerides（TG）， and traditional Chinese medicine quality of life scale scores before treatment and after four weeks，eight weeks，16 weeks，24 weeks，32 weeks，40 weeks，and 52 weeks in the two groups were recorded. The total course of treatment and the total accumulation of hormones were compared among the children with reduced or no hormone treatment till 52 weeks during treatment. ResultThe total effective rate in the observation group was higher （Z=-2.052，P<0.05）. The observation group had lower 24 h UTP and higher ALB at each follow-up time point than the control group（P<0.05，P<0.01）. At four weeks，eight weeks，and 16 weeks of treatment，there was no statistically significant difference in CHO between the observation group and the control group，and the observation group was lower than the control group in CHO at the rest of the time points （P<0.05，P<0.01）. For TG， the observation group was not significantly different from the control group at four weeks，eight weeks，16 weeks，and 40 weeks of treatment，but lower at 24，32，and 52 weeks （P<0.05，P<0.01）. The total treatment course of hormones in the observation group was shorter（P<0.01）， with less total accumulation（P<0.01）. At different follow-up time points，the total score of traditional Chinese medicine quality of life scale in the observation group was superior to that in the control group（P<0.05，P<0.01），and the scores of the observation group in the four dimensions （physiological function，independent factor，social factor，and psychological factor） after treatment were higher than those in the control group（P<0.05，P<0.01）. ConclusionYHQ under sequential syndrome differentiation has a definite clinical effect in treating children with refractory nephrotic syndrome. It has advantages in shortening the total course of hormone treatment and reducing the total accumulation of hormones，and can improve the quality of life of children with refractory nephrotic syndrome.

Clinical Efficacy on Addition and Subtraction Therapy of Zhibai Dihuangwan Combined with Wulingsan on Children with Refractory Nephrotic Syndrome / 中国实验方剂学杂志

Objective:This study aims to investigate the clinical effect of addition and subtraction therapy of Zhibai Dihuangwan combined with Wulingsan in the treatment of refractory nephrotic syndrome （RNS） with Yin deficiency of liver and kidney and its regulatory effect on immune inflammatory response. Method:In this study， 108 children were randomly divided into observation group （54 cases） and control group （54 cases）. Patients in two groups were treated with prednisone acetate tablets combined with tacrolimus capsules . Patients in control group took Liuwei Dihuang oral liquid， 5-10 mL/time， twice a day. Patients in control group were prescribed the addition and subtraction therapy of Zhibai Dihuangwan combined with Wulingsan， 1 dose/day. The course of treatment for both groups was 6 months. The 24 h urine total protein （24 h-UTP）， serum albumin （ALB）， serum creatinine （Scr）， blood urea nitrogen （BUN）， total cholesterol （TC）， triglyceride （TG）， low density lipoprotein （LDL）， high density lipoprotein （HDL）， liver and kidney Yin deficiency syndrome score， fibrinogen （FIB）， <italic>D</italic>-dimer （<italic>D</italic>-D）， prothrombin time （PT） and activated partial thromboplastin time （APTT） were compared before and after treatment. Also， tumor necrosis factor-<italic>α</italic> （TNF- <italic>α</italic>）， interleukin-6（IL-6）， IL-10， IL-17， CD4⁺ and CD8⁺， helper T lymphocytes17 （Th17）， regulatory T cell （Treg） were detected before and after treatment， and CD4⁺/CD8⁺andTh17/Treg were also calculated. Result:The levels of 24 h-UTP， TC， TG， LDL， FIB， <italic>D</italic>-D， TNF-<italic>α</italic>， IL-10， IL-6 and IL-17 in observation group were all lower than those in control group （<italic>P</italic><0.01）， and the levels of CD8⁺， Th17 and Th17/Treg were alsolower than those in control group （<italic>P</italic><0.05）. While the levels of HDL，ALB， CD4⁺， Treg and CD4⁺/CD8⁺ in observation group were higher than those in control group （<italic>P</italic><0.05）. The comprehensive efficacy in observation group was better than that in control group （<italic>Z</italic>=2.02， <italic>P</italic><0.05）， and the traditional Chinese medicine （TCM） syndrome efficacy of observation group was better than that of control group （<italic>Z</italic>=2.10， <italic>P</italic><0.05）. Conclusion:Based on the treatment of hormone combined with Tacrolimus， Zhibai Dihuangwan combined with Wulingsan can reduce urinary protein， improve lipid metabolism disorder and hypercoagulability， and regulate immune inflammatory reaction in patients with RNS and Yin deficiency of liver and kidney， with remarkable comprehensive effect and TCM syndrome effect.

Clinical efficacy of tacrolimus combined with low dose of corticosteroids in treatment of children with refractory nephritic syndrome: A report of 16 cases / 吉林大学学报(医学版)

Objective: To observe the clinical efficacy and safety of tacrolimus (TAC) combined with low dose of corticosteroids in the treatment of the children with refractory nephrotic syndrome (RNS), and to investigate the effect of diltiazem on the blood concentration of TAC. Methods: A total of 16 hospitalized children with refractory nephrotic syndrome (RNS) were selected. All patients were treated with TAC (0. 10-0. 15 mg · kg-1 · d-1) combined with low dose of corticosteroids (1. 0-2. 0 mg · kg-1 · d-1). The concentrations of TAC of the children during the treatment process were monitored. The 24 h urine protein quantitative (UP), plasma albumin (Alb), creatinine and other 6 indexes were recorded before treatment and 2, 4, 8, 12 and 24 weeks after treatment. Results: In 16 cases, 9 cases were completely relieved, 5 cases were partially relieved, and 2 cases were invalid; the total efficiency was 94%. The 24 h UP of 16 children at 24 weeks after treatment was significantly decreased compared with before treatment (Z= - 3. 516, P<0. 01); the plasma Alb level of the children was significantly increased compared with before treatment (Z= - 3.516, P<0. 01). The total cholesterol and triglyceride levels at 2 weeks after treatment were decreased significantly compared with before treatment (Z = - 2. 223, P<0. 05; Z= - 3. 464, P<0. 01). Eight patients had low blood concentration of TAC, and it was increased to an effective concentration after treated with diltiazem. In the course of treatment, creatinine, urea nitrogen and other indexes of the patients were fluctuated in a normal range. Conclusion: TAC combined with low dose of corticosteroids for treatment of RNS is safe and effective, and diltiazem can effectively increase the blood concentration of TAC.

Clinical analysis of cyclophosphamide shock treatment in children with refractory nephropathy / 实用医学杂志

Objective To investigate the effect and adverse reactions of intravenous cyclophosphamide (CTX) pulse therapy on refractory nephrotic syndrome (RNS) in children. Methods Retrospective study was carried on 102 patients with RNS treated with high dose CTX impact treatment in The First Hospital Affiliated to Guangxi Medical University from August 2006 to August 2016. Clinical data and follow-up records were analyzed. Results Biochemical indicators significantly improved after treatment ,and the difference was statistically signifi-cant(P < 0.05). Fifty-six patients achieved complete remission,and 21 patients achieved partial remission,with an effective percentage of 75.5%,and adverse drug reactions incidence rate of 19.6%. There was not significant difference in the remission rate of different clinical types. Conclusions High dose of CTX shock treatment on children refractory nephrotic syndrome is effective ,with low adverse reactions incidence.

Research Progress in Tacrolimus Used in Children with Refractory Nephrotic Syndrome / 中国药师

Tacrolimus is a kind of calcineurin inhibitor ( CNI) , and it is a novel immunosuppressant with similar efficacy to ciclos-porin. This paper reviewed the recent advances in the treatment of refractory nephrotic syndrome in children with tacrolimus, including the comparison of efficacy, dosage, adverse effects and clinical evaluation with the other immunosuppressive agents such as ciclosporin and mycophenolate mofetil in order to provide reference for clinics.

Clinical analysis of cyclophosphamide shock treatment in children with refractory nephropathy / 实用医学杂志

Objective To investigate the effect and adverse reactions of intravenous cyclophosphamide (CTX) pulse therapy on refractory nephrotic syndrome (RNS) in children. Methods Retrospective study was carried on 102 patients with RNS treated with high dose CTX impact treatment in The First Hospital Affiliated to Guangxi Medical University from August 2006 to August 2016. Clinical data and follow-up records were analyzed. Results Biochemical indicators significantly improved after treatment ,and the difference was statistically signifi-cant(P < 0.05). Fifty-six patients achieved complete remission,and 21 patients achieved partial remission,with an effective percentage of 75.5%,and adverse drug reactions incidence rate of 19.6%. There was not significant difference in the remission rate of different clinical types. Conclusions High dose of CTX shock treatment on children refractory nephrotic syndrome is effective ,with low adverse reactions incidence.

Clinical Observation of Enhanced Immunosuppressive Therapy in the Treatment of Refractory Nephrotic Syndrome / 中国药房

OBJECTIVE:To observe the clinical efficacy and safety of enhanced immunosuppressive therapy in the treatment of refractory nephrotic syndrome (RNS). METHODS:Totally 76 RNS patients were selected from 2 hospitals during Jan. 2012-Mar. 2015,and then divided into control group and observation group according to random number table,with 38 cases in each group. Two groups were given Prednisone acetate tablet 50 mg,qd;decreasing to 15 mg,qd,after urine protein returned to normal. Based on it,control group was given Leflunomide tablets 50 mg,qd;decreasing to 20 mg,qd,3 days later. Based on con-trol group,observation group was additionally given Mycophenolate mofetil dispersible tablet 750 mg,bid;decreasing to 500 mg, qd,3 months later. Both groups were treated for 6 months. Clinical efficacies,follow-up recurrence rate as well as renal function in-dexes and inflammatory cell factors before and after treatment,and the occurrence of ADR were compared between 2 groups. RE-SULTS:The total response rate of observation group(92.11%)was significantly higher than control group(73.68%),and fol-low-up recurrence rate(5.26%)was significantly lower than control group(23.68%),with statistical significance(P0.05). After treatment,24 h urinary protein quantification,urinary IL-6 and IL-8 levels of 2 groups decreased significantly,while the content of serum protein increased significantly;the observation group was significantly better than the control group,with sta-tistical significance(P0.05). The incidence of ADR in the control group and the observation group was 34.21% and 44.74% respec-tively,without statistical significance between 2 groups(P>0.05). CONCLUSIONS:Enhanced immunosuppressive therapy in the treatment of RNS can improve renal function,reduce inflammatory reaction and long-term recurrence risk,and have good therapeu-tic efficacy and safety.

Effect of three kinds of low molecular weight heparin combined with methylprednisolone on the high coagulation state and renal function in refractory nephrotic syndrome / 中国生化药物杂志

Objective To investigate the effect of three kinds of low molecular weight heparin combined with methylprednisolone on the high coagulation state and renal function in patients with refractory nephrotic syndrome.Methods 140 cases of refractory nephrotic syndrome were divided into four groups, 35 cases in each group.The control group were treated with methylprednisolone.Small, medium, and large dose group in the control group on the basis of the treatment, were given low molecular weight heparin on once every other day, once daily, twice daily treatment, 3075 AxaIU per times.The improvement of renal function and high coagulation state were compared between the four groups before and after treatment.In the course of treatment, the occurrence of adverse reactions was recorded.Results Remission rate in large, medium and small dose group remission rate was higher than the control group(χ2 =4.375,P<0.05); there was no significant difference in remission rate of three different dose groups.The 24h urine protein and ALB of the four groups after treatment were significantly increased, BUN and SCr were significantly lower(P<0.05).The 24h urine protein, ALB, BUN, SCr of improvement of large, medium and small dose group were significantly better than the control group( P<0.05).The 24 h urine protein, ALB, BUN, SCr in large dose group improved significantly better than those in small dose group(P<0.05).The APTT, PT in large, medium and small dose groups after treatment increased significantly, FIB decreased significantly(P<0.05).The improvement of FIB, APTT, PT in large, medium and small dose group were significantly better than the control group after treatment ( P <0.05 ).The FIB, APTT, PT in large dose group improved significantly better than those in medium and small dose group ( P <0.05 ) .Conclusion The low molecular weight heparin combined with methylprednisolone can significantly improve hypercoagulable state and renal function in the patients with refractory nephrotic syndrome, and the large dose of low molecular weight heparin effect is the best, and no significant adverse reactions occurred.

Efficacy and safety analysis of different doses of low molecular weight heparin combined with hormone in refractory nephrotic syndrome / 中国生化药物杂志

Objective To discuss the efficacy and safety analysis of different doses of low molecular weight heparin combined with hormone in the treatment of refractory nephrotic syndrome.Methods 60 cases of patients with refractory nephrotic syndrome in our hospital from January 2014 to January 2016 were selected,According to the random number table,60 patients were divided into high,medium and low dose of low molecular weight heparin group and control group,control group were treated with hormonal therapy,the high,medium and low dose of low molecular weight heparin group were injected low-molecular-weight heparin calcium on the basis of the control group,twice daily,once daily and every other day,respectively.Results After treatment,the clinical total effective rate of the high,medium and low dose group and control group patients was 14(93.3%),12(80.0%),10(66.7%) and 9(60.0%)respectively,the total efficiency of the high dose group was significantly higher than that of the control group(P<0.05),while there was no significant difference among control,medium and low dose group.The 24 h urine protein quantitation,ALB and Cr in high dose group improved better than those in medium and low dose group(P<0.05).The TG,TC and LDL in high dose group improved better than those in control group(P<0.05). The prothrombin time(PT)and activated partial thromboplastin time(APTT)in high and medium dose group were longer than those in control group(P<0.05),while fibrinogen(FIB)was lower(P<0.05).The PT in low dose group was longer than control group(P<0.05),while there was no significant difference in other coagulation indicators compared with control group.The APTT in high dose group was longer than low dose group(P<0.05).There was no obvious adverse reactions among each dose group.Conclusion The clinical curative effect in different doses of low molecular weight heparin combined with hormone in the treatment of refractory nephrotic syndrome is better,which could be significantly improved in patients with hypercoagulable state,especially effect of high dose group is more obvious.

Glucocorticoid combined with mycophenolate mofetil versus cyclophosphamide in the treatment for adult refractory nephrotic syndrome:a Meta-analysis / 天津医药

Objective To systematically review the efficacy and safety of mycophenolate mofetil versus cyclophosphamide in adults with refractory nephrotic syndrome. Methods The randomized controlled trials of mycophenolate mofetil and cyclophosphamide treatment for refractory nephrotic syndrome were searched from Cochrane library, PubMed, Embase, Wanfang, VIP and CNKI till March 2014. The relevant studies were screened according to inclusion criteria and exclusion criteria. The quality of the included studies was evaluated. Meta-analyses were performed by using RevMan 5.2 software. The indexes were analyzed including the complete remission rate, efficiency, serum albumin, and adverse reaction after completing the treatment for adults with refractory nephrotic syndrome. Results There were 9 RCTs, a total of 467 patients were enrolled. The result of the meta-analysis showed that mycophenolate mofetil could significantly increase complete remission rate (RR=1.45, 95%CI=1.17～1.81, P=0.000 7) and efficiency rate (RR=1.23, 95%CI=1.11～1.36, P＜0.000 1). It can also enhance the level of serum albumin (WMD=2.73, 95%CI=1.42～4.04, P＜0.000 1) and decrease 24-hour urinary protein (SMD=-0.63, 95%CI=-1.16～-0.10, P=0.02) compared with cyclophosphamide in the treatment of refractory nephrotic syndrome. There was no significant difference in the serum level of cholesterol between mycophenolate mofetil group and cyclophosphamide group (SMD=0.31, 95%CI=-0.23～0.84, P=0.26 ). The incidence rates of liver dysfunction (RR=0.13,95%CI=0.06～0.28, P＜0.000 01), leukopenia (RR=0.10, 95%CI=0.04～0.23, P＜0.000 01), gastrointestinal reaction (RR=0.21, 95%CI=0.11～0.39, P＜0.000 01) and alopecia (RR=0.08, 95%CI=0.02～0.29, P＜0.000 01) were significantly lower in mycophenolate mofetil group than those of cyclophosphamide group. There were no significant differences in respiratory tract infection rate (RR=0.68, 95%CI=0.41～1.14, P=0.14) and lung infection rate (RR=0.58, 95%CI=0.31～1.08, P=0.09) between the two groups. Conclusion The safety and efficacy are better in the treatment of refractory nephrotic syndrome using mycophenolate mofetil than that of cyclophosphamide.

Discussion on Professor Huang Chunlin's TCM Medication Experiences for Patients with Hypoalbuminemia in Refractory Nephrotic Syndrome / 世界科学技术-中医药现代化

This paper summarized Professor Huang Chunlin's traditional Chinese medicine (TCM) medication expe-riences for patients with hypoalbuminemia in refractory nephrotic syndrome (RNS). This paper was divided into three parts. The first part was the overview of hypoalbuminemia in RNS. The second part was the TCM medica-tion experiences for patients with hypoalbuminemia in RNS which included the integrated application of tonifying the spleen, nourishing the liver and reinforcing the kidney. The third part was the explanation of the comprehen-sive application of Professor Huang Chunlin's TCM medication experiences for patients with hypoalbuminemia in RNS through the introduction of a typical case. TCM medication experiences for RNS treatment based on experi-ences of famous TCM doctors provided theoretical and practical basis for therapeutic regimen.

Effect of Ciclosporin Treatment on Refractory Nephrotic Syndrome in Children / 实用儿科临床杂志

Objective To observe the effect of ciclosporin(CsA) treatment on children with refractory nephrotic syndrome(NS).Met-hods Combination treatment of CsA[3-5 mg/(kg?d)] and prednisone were given 55 cases with refractory NS,in which including steroid-dependent NS(SDNS) 3 cases,steroid-resistant NS(SRNS) 22 cases,frequent-relapses NS(FRNS) 30 cases.Concentration of CsA was maintained 100-200 ng/L.Course of treatment was 10 months,the dose was tapered gradually in 4 months.Scr,BUN,Alb,ALT,Ccr,Chol,24 hours urine protein quantitation was measured before and after CsA treatment.Side effect of CsA was observed at the same time.SPSS 13.0 software was used to analyze the data.Results Forty-one cases(74.5%) were complete remission,6 cases(10.9%) were partial remission,total effective rate was 85.5%.Remission rate was 97.6% in simple type NS,50.0% in nephritis type NS,100% in SDNS and FRNS groups,63.6% in SRNS group.In group minimal change disease(MCD),the remission rate was 100.0%,while 60.0% in group mesangial prolife-rative glomerulonephritis(MsPGN),and 42.9% in group focal segmental glomerulosclerosis(FSGS).Fifteen cases(31.9%) relapsed when the dose of CsA was tapering.The adverse effects included hairiness(55 cases),gum hypertrophy(16 cases),hypertension(9 cases),gastroi-ntestinal tract reaction(8 cases),but no obvious nephric adverse effects were observed during the treatment process.Conclusion CsA is safe and effective on refractory NS children,especially to those with SDNS,FRNS and MCD.

Clinical Study of Honghua Injection Plus Prednisone and Cyclophosphamine Treatment on Refractory Nephrotic Syndrome / 浙江中医药大学学报

[Objective] To investigate the therapeutic effect of Honghua injection plus prednisone and cyclophosphamine on refractory nephrotic syndrom.[Methods] 38 patients with refractory nephrotic syndrom were given intravenous Honghua and cyclophosphamine plus oral prednisone.Serum total cholesterol,triglyceride,liver and renal function,blood routine test,24h protennuria were observed.[Results] Total effective ratio was 92.1%.Cure ratio was 73.68%.Partly cure ratio was 18.42% and ineffective ratio was 7.89%.[Conclusions] Patients with refractory nephrotic syndrom were treated by Honghua injection plus prednisone and cyclophosphamine,which could reduce the application of prednisone,its side effects and enforce its therapeutic effect.What is more,this treatment could lessen therapeutic process,prevent relapse and recoil,protect effectively the retreat syndrom of prednisone as well.

Therapeutic effects of mycophenolate mofetil in refractory nephrotic syndrome / 中国临床药理学与治疗学

AIM:To approach the therapeutic effects of mycophenolate mofetil(MMF)in hormonal resistance nephrotic syndromes.METHODS:Patients were diagnosed as nephrotic syndrome and treated with prednisone at the dose of 1 mg?kg-1?d-1 for over 8 weeks,and 24 patients with unsatisfactory results or were palindromic were selected,and several patients in the 24 patients had been treated with cyclophosphamide or cyclosporine A.All patients were treated with MMF combined with low dose hormone.The initial dose of MMF was 1.0-1.5 g/d for 3 months,later the dose were reduced,and the maintenance dose of MMF was 0.5-1.0 g/d,the dose of prednisone was 5-20 mg/d,the follow-up visit period more than six months.The changes on urine protein,serum albumin,liver function,renal function were compared before and after treatment.RESULTS:Before and after treatment,urine protein decreased from(3.4?1.7)g/d to(0.9?0.2)g/d,serum albumin increased from(19.6?5.4)g/L to(36.1?7.7)g/L.serum creatinine level decreased from(105.7?6.4)?mol/L to(90.1?5.8)g/L.20 patients(83.3%)pathogenetic condition were relieved,15 patients(65.2%)were with complete remission.5 patients(20.8%)were partially recovered,and 4 patients(16.6%)had no response.The adverse effects were observed,including gastrointestinal events(n=8,33.3%),bacterial pneumonia(n=4,16.6%),herpes zoster(n=1,4.1%),hepatic function mild damage(n=3,12.5%).CONCLUSION:It is safe and effective to combine MMF with low dose hormone in treatment of hormonal resistance nephrotic syndrome,which could become a therapeutic option for refractory nephrotic syndrome(RNS).