Treatment Of Primary Nephrotic Syndrome Research Articles

Systematic Evaluation and Reevaluation of Oral Chinese Herbal Decoction in the Treatment of Primary Nephrotic Syndrome

Systematic Evaluation and Reevaluation of Oral Chinese Herbal Decoction in the Treatment of Primary Nephrotic Syndrome

Retracted: Study on the Effect of Combination of Prednisone and Vitamin D in the Treatment of Primary Nephrotic Syndrome in Children.

[This retracts the article DOI: 10.1155/2021/7932721.].

Clinical Efficacy of Adjuvant Treatment of Primary Nephrotic Syndrome in Pediatric Patients with Chinese Medicine.

Objective Current study aimed to investigate the benefits of adjuvant therapy with traditional Chinese medicine on the pediatric primary nephrotic syndrome. Methods A total of 455 patients with PNS admitted to our hospital from January 2010 to January 2019 were divided into the traditional Chinese medicine group (n = 217) and the control group (n = 238). The control group received conventional Western medical treatment, and the traditional Chinese medicine group was treated with traditional Chinese medicine supplemented with Western medical treatment. The differences in remission rate, recurrence rate, and recurrence-free survival between the two groups were evaluated. Results The differences in clinical parameters between the two groups were not statistically significant. Compared with the control group, adjuvant treatment with traditional Chinese medicine increased the clinical remission rate (p=0.037), decreased the relapse rate (p=0.015), prolonged relapse-free survival (p ≤ 0.01), and was an independent protective factor for relapse-free survival in children with PNS (HR = 0.55, 95% CI 0.49–0.63, p ≤ 0.01). In a subgroup analysis of the traditional Chinese medicine formulations, Yuebi Jiazhu Tang, Ganlu Xiaodu Dan, and Yupingfeng granules significantly reduced the risk of recurrence in children (p ≤ 0.01, p ≤ 0.01, p=0.003). Conclusion Adjuvant treatment of pediatric primary nephrotic syndrome with traditional Chinese medicine could benefit the children.

Study on the Effect of Combination of Prednisone and Vitamin D in the Treatment of Primary Nephrotic Syndrome in Children.

Objective To study the effect of prednisone combined with vitamin D in the treatment of primary nephrotic syndrome in children. Method 73 cases of primary nephrotic syndrome admitted to the nephrology department of our hospital were randomly selected and retrospectively analyzed. 36 cases were treated with prednisone as the control group, and 37 cases were treated with prednisone combined with vitamin D as the observation group. The efficacy was compared after 3 months of continuous treatment. Result After 3 months of treatment, the blood calcium of the observation group was higher than that of the control group, PTH was lower than that of the control group, and 25-(OH)2D3 and 1,25-(OH)2D3 were higher than those of the control group (P < 0.05). After 1, 2, and 3 months of treatment in the observation group, Scr and 24-h urine protein quantification were lower than those in the control group and eGFR was higher than that in the control group (P < 0.05). CD4+ and CD4+/CD8+ were lower in the observation group than in the control group after 3 months of treatment (P < 0.05). The serum sTfR and TGF-β1 levels were lower in the observation group than in the control group after 3 months of treatment (P < 0.05). The total effective rate of the observation group was 83.78% after 3 months of combined treatment with prednisone and vitamin D, which was significantly higher than the total effective rate of the control group of 61.11% (P < 0.05). The incidence of nausea and vomiting, heartburn, headache, dry cough, hypercalcemia, and constipation during treatment in the observation group was not statistically different from that in the control group (P > 0.05). Conclusion Combined treatment of primary nephrotic syndrome in children with prednisone and vitamin D can more significantly improve the level of clinical indicators, improve renal function and immune function, and obtain more satisfactory efficacy, without significantly affecting the safety of treatment.

Modern pharmacological approaches to primary treatment nephrotic syndrome

The review is devoted to the consideration of the most common drugs currently used in the treatment of primary nephrotic syndrome. Mechanisms of pharmacological activity of glucocorticosteroids, ACTH, calcineurin inhibitors cyclosporine A and tacrolimus, alkylating compounds cyclophosphamide and chlorambucil, mycophenolate mofetil, levamisole, abatacept, rituximab and a number of other recently created monoclonal antibodies. An attempt is made to separate the immune and non-immune mechanisms of action of the most common drugs, concerning both the impact on the immunogenetics of the noted diseases and the direct impact on the podocytes that provide permeability of the glomerular filtration barrier and the development of proteinuria. It is shown that the immune mechanisms of corticosteroids are caused by interaction with glucocorticoid receptors of lymphocytes, and nonimmune – with stimulation of the same receptors in podocytes. It was found that the activation of adrenocorticotropic hormone melanocortin receptors contributes to the beneficial effect of the drug in nephrotic syndrome. It is discussed that the immune mechanism of calcineurin inhibitors is provided by the suppression of tissue and humoral immunity, and the non-immune mechanism is largely due to the preservation of the activity of podocyte proteins such as synaptopodin and cofilin. Evidence is presented to show that the beneficial effect of rituximab in glomerulopathies is related to the interaction of the drug with the protein SMPDL-3b in lymphocytes and podocytes. The mechanisms of action of mycophenolate mofetil, inhibiting the activity of the enzyme inosine 5-monophosphate dehydrogenase, which causes the suppression of the synthesis of guanosine nucleotides in both lymphocytes and glomerular mesangium cells, are considered. It is emphasized that the effect of levamisole in nephrotic syndrome is probably associated with the normalization of the ratio of cytokines produced by various T-helpers, as well as with an increase in the expression and activity of glucocorticoid receptors. The mechanisms of pharmacological activity of a number of monoclonal antibodies, as well as galactose, the beneficial effect of which may be provided by binding to the supposed permeability factor produced by lymphocytes, are considered.

Chinese Herbal Injections for Primary Nephrotic Syndrome in Adults: A Systematic Review and Network Meta-Analysis.

Primary nephrotic syndrome (PNS) is a common renal disease that presents with heavy proteinuria and hypoalbuminemia. Despite notable advances in its treatment, some patients show poor responses and clinical outcomes when treated with conventional Western medicine (WM). Chinese herbal injections (CHIs) have been reported to have beneficial effects for PNS. The aim of the present study was to comprehensively determine the efficacy and safety of CHIs for PNS in adults using a network meta-analysis approach. PubMed, Embase, the Cochrane library, and four Chinese databases were systematically searched to identify randomized controlled trials (RCTs) using CHIs for treatment of PNS published before June 1, 2019. Quality assessment of the identified RCTs was performed according to the Cochrane Handbook. Pooled odds ratios (OR) or mean differences (MD) with corresponding 95% confidence intervals (CI) were calculated for discrete or continuous variables, respectively. The primary outcome was complete/total remission and secondary outcomes were serum albumin and urinary protein excretion. The surface under the cumulative ranking curve (SUCRA) value and cluster analyses were used to rank treatment by probability. Eighty-five studies involving 11 CHIs and 5801 subjects were included. Compared with WM alone, CHI plus WM showed an improved complete/total remission rate as well as higher serum albumin and lower 24-hour urinary protein excretion, except in the following: Yinxingye injection plus WM did not improve the total remission rate, and Dengzhanhua or Xueshuantong injection plus WM did not lower the 24-hour urinary protein excretion. Either Danhong (DH) or Dengzhanhua (DZH) injection plus WM was the preferable treatment for PNS based on SUCRA and cluster analyses of clinical remission and adverse events. However, considering that literature in this area is limited, these results need further validation. CHIs administered as adjuvants to WM showed favourable outcomes for PNS. DH + WM and DZH + WM might be the potential optimal therapies for PNS.

Histone deacetylase-2 expression and activity in children with nephrotic syndrome with different glucocorticoid response.

Glucocorticosteroid (GC) is one of the most effective drugs available for the treatment of primary nephrotic syndrome (PNS) in children. However, some patients show little or no response to GC. The purpose of our research was to observe and describe the different levels of histone deacetylase-2 (HDAC2) expression in peripheral blood lymphocytes in children with PNS compared with various responses to the GC treatment, with the primary aim to assess the correlation between HDAC2 and GC resistance in PNS children. Forty-eight patients with PNS suffering from their first attack prior to GC treatment were chosen as subjects. They were divided into two groups, those who had steroid-sensitive nephrotic syndrome (SSNS; n = 25) and those with steroid-resistant NS (SRNS; n = 23), according to their response to a 6-week course of oral prednisone. Twenty healthy children from the Physical Examination Center in the hospital served as the control group; Peripheral blood was collected at different time points prior to GC treatment and after regular therapy. RT-PCR, western blot, and enzyme-linked immunosorbent assay (ELISA) techniques were adopted to analyze HDAC2 mRNA, protein expression, and activity, respectively, in peripheral blood lymphocytes. The level of interleukin-8 (IL-8) in serum was measured by an ELISA. Prior to GC treatment, HDAC2 expression level and activity were lower in the SRNS group than in the SSNS and control group. A statistically significant difference in HDAC2 expression and activity were observed after GC treatment between these groups, with HDAC2 expression and activity lower in the SRNS group than in the SSNS and control groups. In the SSNS group, the expression and activity of HDAC2 were higher following GC treatment than prior to GC treatment. There was a clear difference in HDAC2 expression and activity of SRNS at the different time points. No statistically significant difference was found between the two groups. The pre-treatment and post-treatment serum IL-8 levels in the SRNS group were significantly higher than those in the SSNS group. HDAC2 from children with PNS before GC treatment and after regular therapy for 6 weeks was negatively correlated with serum IL-8 level. The GC effect was influenced by the HDAC2 expression and activity, leading to decreased serum IL-8 levels in children with PNS. HDAC2 seems to be one of the markers of GC resistance in children with PNS.

Clinical observation on treatment of primary nephrotic syndrome with integrated Chinese and Western medicine

Purpose:observe integrated Chinese and Western medicine(bushen jianpi dampness soup+glucocorticoids)Clinical effects of treating primary nephrotic syndrome.method:willGeneral patientswith primary nephrotic syndrome randomly divided into2Groupexample.thecontrol group was treated with glucocorticoid-oriented western medicine,treatment Group oncontrol Group on the basis of the use of self-made bushen JIANPI dampness decoction treatment,Both groups of sessions are6month.result:treatment groupeffect20example,valid?Example,Invalid5Example,The total effective rate is90.6%Thecontrol groupis doing theExample,validExample,isnot validExample,The total effective rate is73.6%.treatment Group after treatmentTG(Glycerol IIIunitary ester,CH(cholesterol^,Alb(white protein)andhours of urine protein water average better than before treatment,compared with control group,Difference has statisticsmeaning(P<0.05.conclusion:efficacy of integratedChinese and Western medicine in treating primary nephrotic syndrome is better than Western medicine alone.

Analysis on clinical value of low molecular weight heparin for the treatment of primary nephrotic syndrome associated with a hypercoagulable state

Objective To investigate the clinical value of low molecular weight heparin for the treatment of primary nephrotic syndrome associated with a hypercoagulable state.Methods 60 cases of primary nephrotic syndrome associated with a hypercoagulable state in our hospital were randomly divided into control group and observation group.The control group was treated with dipyridamole tablets.The observation group was treated with low molecular weight heparin.The urinary protein,serum cholesterol,albumin,PT,APTT and DD before and after treatment of two groups were compared.Results Each index of two groups before treatment had no significant difference (P ＞ 0.05).The urinary protein,serum cholesterol,albumin and DD of observation group after treatment were significantly better than those of control group (P ＜ 0.05).PT and APTT of observation group were (12.5 ± 2.2)s and (35.9 ± 7.1)s respectively,which were significantly higher than those of control group as (10.1 ± 1.9)s and (30.8 ± 7.3)s (P ＜ 0.05).Conclusion Low molecular weight heparin for primary nephrotic syndrome associated with a hypercoagulable state has exact effect.It can significantly improve hypercoagulable state and reduce proteinuria. Key words: Low molecular weight heparin; Primary nephrotic syndrome; Hypercoagulable state

Low-dose heparin micro-pump continuous regular infusion in the treatment of primary nephrotic syndrome

：Objective To explore theefficacy and safety of low-dose heparin in the treament of children with primary nephroticsyndrome (PNS). Methods It was an open and comparative trial. Eightyeight children withPNS in the hypercoagulable state,on the basis of administrating withglucocorticosteroid,were administrated with low-dose heparin that infused by micro pumporiented to time ( group A). Eighty patients only treated with glucocorticosteroid werechosen as control (group B). Results Serum-albumin and activated partial thromboplastintime (APTT) increased,but fibrinogen (Fib) decreased after therapy in the group A,and theyall showed significant differences (P ＜0. 01 ).Serum-albumin increased after therapy in the group B and there was significant difference(P＜0. 01 ). However,APTT and Fib in the group B showed no significantdifference( P ＞ 0. 05 ) betweenpost-treatment and pretherapy. Post-treatment serum-albumin and APTT in the group A weresignificantly higher than those in group B, and Fib was significantly lower than that ingroup B ( P ＜ 0. 01 ). The rate of urineprotein remission in group A (82/88) was significantly higher than that in group B(63/80). Urine protein remission time and edema disappearance time were significantlyshorter in group A than group B ( P ＜0. 01 ). APTT ofgroup A at the peak concentration of heparin after therapy was significantly higher thanthat of pretherapy ( P ＜ 0. 01 ), and the ratio was 2.38. However, there was no significant difference in APTT at the valley concentration ofheparin between post-treatment and pretherapy ( P ＞ 0.05 ). Conclusion Low dose-heparin infused by micro pumporiented to time in the treatment of children with PNS has an obvious anticoagulativeeffect. It can improve the rate of urine protein remission and shorten edema disappearancetime. Meanwhile it is safety ,requires no laboratory monitor and has few drug sideeffects,thus it deserves further clinical apphcation. Key words: Low-dose heparin ; Primary nephrotic syndrome; Hypercoagulative state ; Children

Treatment aspects of primary nephrotic syndrome in adults.

Strict therapy protocol, which would be used universally for certain morphological forms of primary nephrotic syndrome, does not exist. The aim of the study was to show the effects of used therapy protocol in treatment of primary nephrotic syndrome at the Institute of Nephrology, Clinical Center University of Sarajevo in period of 2000-2005. The retrospective analysis covered 48 patients (17 women and 31 men) with idiopathic nephrotic syndrome, where pathomorphological changes were proved by kidney biopsy. Minimal change disease was confirmed with 6 (12.5%) patients. All patients were initially treated with corticosteroids with dose of 1 mg/kg of body weight. Five patients were in the group of primary responders (83.3%) with long term total remission, and 1 patient (16.6%) was a primary responder with 3 relapses in 8 months with a therapy of corticosteroids and bolus of cyclophosphamide. Diffuse mesangial proliferative glomerulonephritis was shown in 13 patients (27.1%). Seven patients from this group were treated with corticosteroid therapy (1 mg/kg of body weight for 4 weeks, followed by 0.5 mg/ kg of body weight until therapeutical response was achieved, and finally gradual exclusion of therapy after eight weeks in responsive patients). Six patients were treated with corticosteroids and one-month of bolus cyclophosphamide during half of year (10-5 mg/kg of body weight). Total remission was achieved in 37,9% of the patients. The IgA nephropathy presented with the nephrotic syndrome was shown in 10.4% (5) of the patients. Three patients from this group were treated with corticosteroid therapy (1 mg/kg of body weight for 4 weeks, followed by 0,5 mg/ kg of body weight until therapeutical response was achieved, and finally gradual exclusion of therapy after eight weeks in responsive patients) and.2 patients with corticosteroids and cyclophosphamide (1.5 mg/kg of body weight) during 6 months. Complete remission of nephrotic syndrome from this pathomorphological category was achieved in 2 patients. Membranoproliferative glomerulonephritis was shown in 6 patients (12.5%). All were treated with corticosteroids plus bolus of cyclophosphamide. Partial remission was achieved in one patient. Membranous glomerulonephritis was confirmed in 18 patients (37.5 %). Combined therapy of corticosteroids and bolus of cyclophosphamide was used in 7/18 patients, in 2/18 patients therapy of corticosteroids and per os cyclophosphamide (2 mg/kg of body weight) and in 9/18 patients cyclosporine therapy (3 mg/kg of body weight). Complete remission was achieved in 38.8% of the patients. A high percentage of achieved remissions of primary nephrotic syndrome in adults shows the efficiency of immunomodulating therapy used. Membranoproliferative glomerulonephritis still remains a therapy problem.