Abstract
Objective At present, the most appropriate management of Henoch–Schonlein purpura nephritis (HSPN) with nephrotic-range proteinuria still remains controversial; thus, the purpose of this study is to evaluate safety and efficacy of traditional Chinese medicine (TCM), Qingre-Lishi-Yishen Formula (QLYF), integrated with regular oral glucocorticoid and cyclophosphamide intravenous pulse therapeutic regimen in children suffered from moderately severe HSPN with nephrotic proteinuria. Methods From 1 January 2012, to 1 January 2016, totally 150 hospitalized children suffered from HSPN with nephrotic proteinuria were included. All were treated with glucocorticoid and cyclophosphamide, and 100 of them were treated with integrative traditional Chinese decoction QLYF. Patients were followed up for 2 years. Rate of adverse event occurrence, short-term clinical effects, long-term clinical effects, and TCM therapeutic evaluation were all compared. Results Total adverse event rate was lower in the QLYF group (χ2 = 5.357, p = 0.022); rates of respiratory infection, urinary infection, poor appetite, hepatotoxity, cardiotoxicity, and neutropenia were all decreased in patients who received QLYF (p = 0.022); rates of respiratory infection, urinary infection, poor appetite, hepatotoxity, cardiotoxicity, and neutropenia were all decreased in patients who received QLYF (p = 0.022); rates of respiratory infection, urinary infection, poor appetite, hepatotoxity, cardiotoxicity, and neutropenia were all decreased in patients who received QLYF (p = 0.022); rates of respiratory infection, urinary infection, poor appetite, hepatotoxity, cardiotoxicity, and neutropenia were all decreased in patients who received QLYF (p = 0.022); rates of respiratory infection, urinary infection, poor appetite, hepatotoxity, cardiotoxicity, and neutropenia were all decreased in patients who received QLYF (p = 0.022); rates of respiratory infection, urinary infection, poor appetite, hepatotoxity, cardiotoxicity, and neutropenia were all decreased in patients who received QLYF (Conclusion Compared with merely using regular oral glucocorticoid plus cyclophosphamide pulse therapeutic regimen, the therapeutic regimen that integrates QLYF with the abovementioned western medicine might be a safe means to decrease the occurrence rate of adverse events and improve short-term and long-term clinical effects in children who suffered from moderately severe HSPN with nephrotic proteinuria.
Highlights
Henoch–Schonlein purpura (HSP) is an immunoglobulin A- (IgA-) mediated disease characterized by a generalized vasculitis mainly involving the skin, joints, gastrointestinal tract, and kidneys [1, 2]
In one 20-year follow-up study, Henoch–Schonlein purpura nephritis (HSPN) leads to the chronic kidney disease (CKD) in up to 20% affected children; the ratio could be as high as 40% for children initially expressed as the moderately severe HSPN with nephrotic-range proteinuria [5]. erefore, effective therapeutic interventions are considered necessary to prevent progressing to end-stage renal disease (ESRD)
From 1 January 2012, to 1 January 2016, 150 moderately severe HSPN children with nephrotic proteinuria were enrolled continuously. e diagnosis of HSPN with nephrotic proteinuria is based on the evidence-based guideline for diagnosis and treatment of HSPN revised by the Kidney Group of Chinese Pediatric Society, Chinese Medical Association [15]. e inclusion criteria were as follows: (1) age of 5–16 years; (2) 24 hour proteinuria
Summary
Henoch–Schonlein purpura (HSP) is an immunoglobulin A- (IgA-) mediated disease characterized by a generalized vasculitis mainly involving the skin, joints, gastrointestinal tract, and kidneys [1, 2]. The long-term prognosis of HSP mainly depends on the severity of renal involvement, termed Henoch–Schonlein purpura nephritis (HSPN) [3, 4]. In one 20-year follow-up study, HSPN leads to the chronic kidney disease (CKD) in up to 20% affected children; the ratio could be as high as 40% for children initially expressed as the moderately severe HSPN with nephrotic-range proteinuria [5]. The immunosuppressant usage may exert therapeutic effect but may be blamed for severe adverse events both in the short-term and in the long-term. Cyclophosphamide is one of the most commonly used alkylating agents, which can exert immunosuppressive function by causing cytotoxic and antiproliferative effects on various immune cells. e longterm use of cyclophosphamide may give rise to gastrointestinal effects (nausea and vomiting), liver toxicity, myocardial damage, bone marrow toxicity, bladder toxicity, and gonadal toxicity [9]
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