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 am unsure 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, and fluid intake should be limited during severe edema.2 If infection is present, administer antibiotics that do not harm the kidneys (e.g., penicillin).
3 Diuretics: Oral hydrochlorothiazide or spironolactone may be used, and furosemide may be added if 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 total 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 every other day, with the total daily dose taken once in the morning. This should be continued for another 4 weeks, after which the dose should be reduced every 2–4 weeks until the medication is stopped. The total treatment duration is 4–6 months.
If urine protein does not disappear within the first 4 weeks of treatment, the course should be extended. The dose should not be changed to every other day, but the original dose should be continued for another 4 weeks. If urine protein is negative for 3 consecutive times within 8 weeks (7–10 days each time), the dose can then be reduced to every other day, with the total daily dose taken once in the morning, for another 4 weeks. Afterward, the dose should be reduced every 2–4 weeks until the medication is stopped. The total treatment duration is extended to 9–12 months.
6 If hormone therapy is ineffective or toxic side effects occur, immunosuppressive therapy (e.g., cyclophosphamide, phenylbutazone, or nitrogen mustard) may be used instead.
7 Traditional Chinese Medicine (TCM) treatment:
- For spleen deficiency type: Bu Zhong Yi Qi Tang combined with modified Wu Ling San (including ginseng, white, tangerine peel, Poria, poria, alisma, corn silk, magnolia bark, bitter gourd, and licorice).
- For spleen-kidney yang deficiency type: Shi Pi Tang combined with Fang Ji Huang Qi Tang (including aconite, dry ginger, Poria, white, polygonum, Chinese yam, morinda, epimedium, and Eucommia ulmoides).