Patient's question:
The child has had nephrotic syndrome for 5 years, with frequent relapses. The treatment mainly involves prednisone. If the dosage is reduced to 1 tablet or half a tablet, it will relapse. Currently, there has been no recurrence for a year. I don't know if it will flare up again in the future. Please advise the experts. Thank you!Doctor's answer:
Diet: Generally, no dietary restrictions are needed. Protein should be increased moderately, but should be limited in cases of azotemia. Sodium intake should be restricted for children with edema and hypertension; fluid intake should also be limited in severe edema.2 If infection is present, administer antibiotics that do not harm the kidneys (e.g., penicillin).
3 Diuretics: Oral hydrochlorothiazide or spironolactone can be used, with furosemide reserved for when necessary.
4 Plasma and blood protein transfusions can increase serum protein levels and reduce edema.
5 Hormone therapy: Prednisone is often taken orally, with diuretic, anti-edema, and proteinuria-reducing effects. The daily dose should be divided into 3–4 doses and taken for 4 weeks. If urine protein is negative for 3 consecutive times within 7–10 days (i.e., no protein detected in urine tests), the dose should be reduced to alternate-day morning single-dose administration for another 4 weeks. Afterward, the dose should be reduced every 2–4 weeks until the medication is stopped, with a total treatment duration of 4–6 months.
If urine protein does not disappear within the first 4 weeks of treatment, the course should be extended. The alternate-day single-dose regimen should not be started; instead, continue the original dose for another 4 weeks. If urine protein remains negative for 3 consecutive times within 8 weeks (7–10 days each), switch to alternate-day morning single-dose administration for another 4 weeks, followed by dose reductions every 2–4 weeks until the medication is stopped. The total treatment duration will then be extended to 9–12 months.
6 If hormone therapy is ineffective or toxic side effects occur, immunosuppressants (e.g., cyclophosphamide, chlorambucil, or nitrogen mustard) can be used instead.
7 Traditional Chinese Medicine (TCM) treatment:
- For spleen deficiency type: Bu Zhong Yi Qi Tang combined with modified Wu Ling San (Partyang, Bai Zhu, Chen Pi, Fu Ling, Zhu Ling, Ze Xie, Yu Mi Xu, Hou Pu, Jiao Gan Cao).
- For spleen-kidney yang deficiency type: Shi Pi Tang combined with Fang Ji Huang Qi Tang (Fu Zi, Gan Jiang, Fu Ling, Bai Zhu, Fang Ji, Shan Yao, Ba Ji Rou, Rou Cong Rong, Xian Ling Pi).