Abstract
Aims. To explore whether Astragalus or its formulations could prevent upper respiratory infection in children with nephrotic syndrome and how best to use it. Methods. We transformed a common clinical question in practice to an answerable question according to the PICO principle. Databases, including the Cochrane Library (Issue 5, 2012), PUBMED (1966–2012.8), CBM (1978–2012.8), VIP (1989–2012.8), and CNKI (1979–2012.8), were searched to identify Cochrane systematic reviews and clinical trials. Then, the quality of and recommendations from the clinical evidence were evaluated using the GRADEpro software. Results. The search yielded 537 papers. Only two studies with high validity were included for synthesis calculations. The results showed that Astragalus granules could effectively reduce URTI in children with nephrotic syndrome compared with prednisone treatment alone (23.9% versus 42.9%; RR = 0.56 and 95% CI = 0.33–0.93). The dose of Astragalus granules was 2.25 gram (equivalent to 15 gram crude Astragalus) twice per day, at least for 3–6 months. The level of evidence quality was low, but we still recommended the evidence to the patient according to GRADEpro with the opinion of the expert. Followup showed the incidence of URTI in this child decreased significantly. Conclusions. Astragalus granules may reduce the incidence of URTI in children with nephrotic syndrome.
Highlights
Infection is one of the most common complications in children with nephrotic syndrome (NS)
The annual incidence of invasive bacterial infection based on retrospective case series was shown to be about 1-2%, and the cumulative risk for the 10-year susceptibility period was around 10–20% [1]
The most commonly reported infection accompanying nephrotic syndrome was upper respiratory infection (8.8–29.27%) [6,7,8]. Most of these infections were closely associated with frequent relapses in children with nephrosis [9], especially viral upper respiratory tract infections (URTI) [10, 11], which resulted in significant admission rates and healthcare costs
Summary
Infection is one of the most common complications in children with nephrotic syndrome (NS). In China, the incidence of nosocomial infection has been reported to be as high as 34–79% in children with nephrosis [2,3,4] and 22% in adults [5]. Various prophylactic interventions have been used and/or recommended for reducing the risk of infection in nephrotic patients in clinical practice. These include chemoprophylaxis with antibiotics, pneumococcal vaccines, and immunoglobulin replacement therapies [1, 13]. The effectiveness of these prophylactic therapies has not been confirmed, and these treatments are quite expensive and still have some adverse effects [14]
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