7 Questions About Nephrotic Syndrome And Glucocorticoids

Glucocorticoids play an important role in the treatment of nephrotic syndrome. Not only can it significantly alleviate the condition of nephrotic syndrome, the patient's initial response to hormone therapy can also be used as an important indicator to predict their long-term prognosis. Let's learn it together.

01 What are the diagnostic criteria for primary nephrotic syndrome?

Adults [1]: ① Massive proteinuria, urinary protein ≥ 3.5g/L; ② Hypoalbuminemia, plasma albumin < 30g/L; ③ Elevated blood lipids; ④ Edema. Among the above four items, ① and ② are necessary conditions for diagnosis.

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Children [2]: Includes two items: ① Proteinuria within the nephrotic range [defined as morning urine or 24h urine protein to creatinine ratio (UPCR) ≥ 2 mg/g or 200 mg/mmol or 3+ and above]; ② Combined with hypoalbuminemia When symptoms [serum albumin <30g/L (3g/dL)] or albumin level cannot be measured, the patient is found to have edema.

02 What are the types of glucocorticoids?

There are many types of glucocorticoids, which can be divided into three types: short-acting, medium-acting and long-acting according to their half-lives.

Short-acting: The biological half-life is 6 to 12 hours, such as cortisone and hydrocortisone; the anti-inflammatory effect is relatively weak, the action time is short, and the impact on the hypothalamic-pituitary-adrenal axis (HPA axis) is mild.

Medium effect: Biological half-life is 12 to 36 hours, such as prednisone, prednisolone, methylprednisolone, triamcinolone acetonide, etc.; anti-inflammatory effect and half-life are between short-acting and long-acting hormones, and side effects are relatively small.

Long-term effect: biological half-life is 48 to 72 hours, such as dexamethasone, betamethasone, etc. It has a stronger anti-inflammatory effect and a longer acting effect, but it also has a stronger inhibitory effect on the HPA axis.

03 Why are intermediate-acting glucocorticoids suitable for nephrotic syndrome?

Differences in the molecular structure and pharmacological properties of glucocorticoids may lead to differences in clinical efficacy and safety. At present, the most commonly used medium-acting glucocorticoid preparations for nephrotic syndrome are prednisone, prednisolone, and methylprednisolone. Among them, methylprednisolone is one of the more ideal glucocorticoid preparations and has the following pharmacological properties and advantages [3]:

① Strong lipophilicity and rapid arrival at the site of action: Methylprednisolone has C6 methylation, which makes it more lipophilic and can quickly pass through the cell membrane to reach the site of action, thus taking effect quickly.

② Active drugs do not require liver conversion: For patients with impaired liver function, it will not increase the burden on the liver.

③High effective drug concentration: Methylprednisolone is less bound to plasma proteins, and there are more free glucocorticoid components in the plasma. Conducive to therapeutic effect.

④ High affinity with receptors: Methylprednisolone has the highest affinity with glucocorticoid receptors, helping it to better exert its anti-inflammatory and immunomodulatory effects.

⑤Constant linear relationship: its free part is always proportional to the dose. Changes in plasma free glucocorticoids caused by changes in hormone dosage can be predicted, allowing for more accurate disease control.

⑥Plasma clearance rate is stable: The plasma clearance rate of methylprednisolone is stable and will not increase with time. The plasma clearance of other drugs, such as prednisolone, increases with prolonged administration, resulting in a decrease in effective plasma concentration.

⑦Mineralocorticoid-like effects are weak and side effects are small: the side effects of water and sodium retention caused by it are small.

05 Application methods of glucocorticoids[5,6]

Basic principles: The use of glucocorticoids should follow the principle of "adequate dosage, slow reduction, and long-term maintenance".

The initial dose should be sufficient: prednisone 1.0 mg/(kg·d) taken once, and the maximum dose should not exceed 80 mg/d for 6 to 8 weeks. In some patients, it can be extended to 12 to 16 weeks according to the pathological type.

Slowly reduce the dosage: reduce the original dosage by 10% every 1 to 2 weeks; when reducing to about 20mg, special attention should be paid to avoid recurrence.

Low-dose maintenance treatment: For patients who often relapse, after complete remission or after completing a course of high-dose treatment, the dose can be gradually reduced to a low dose, and can be taken once every other day for at least 3 to 6 months.

06 Instructions for use in children with new-onset nephrotic syndrome[2]

initial treatment

Recommendation: Oral glucocorticoid treatment for 8 or 12 weeks, with daily administration for the first 4/6 weeks and every other day for the last 4/6 weeks.

Dosage: In the first 4/6 weeks, prednisone or prednisolone 60 mg/㎡/d or 2 mg/kg/d (maximum not exceeding 60 mg/d); in the next 4/6 weeks, 40 mg/㎡ or 1.5 mg/m2 every other day. mg/kg (maximum not exceeding 50mg).

Prevent recurrence

Recommendation: Daily glucocorticoids should not be routinely given during upper respiratory tract infections in children with frequent relapses and steroid dependence.

Practice: For children with frequent relapses or steroid dependence, low-dose and short-course glucocorticoid treatment may be considered when they have upper respiratory tract infections or have a history of infection-related relapses.

Relapse treatment

Recommendation: For children with severe glucocorticoid-related adverse reactions, frequent relapses, or hormone dependence, drugs that reduce the dosage of glucocorticoids should be prescribed.

Initial treatment for recurrence: prednisolone 60 mg/㎡/d or 2 mg/kg/d (not to exceed 60 mg/d). Discontinue the drug after remission.

Post-remission treatment: Reduce prednisone/prednisolone to 40 mg/m or 1.5 mg/kg (maximum 50 mg) orally every other day for ≥ 4 weeks.

Subsequent relapse: Children with frequent relapses or steroid-dependent patients without glucocorticoid toxicity can continue to use the same regimen.

Combination medication: Before starting glucocorticoid-reducing drugs, patients should achieve remission on glucocorticoid therapy, and combination therapy is recommended for ≥2 weeks.

07 What are the precautions for taking glucocorticoids?

Glucocorticoids can have both beneficial and adverse effects on the body. When indications and contraindications coexist, a comprehensive analysis should be conducted, the pros and cons should be weighed, and a careful decision should be made. Patients in critical condition still need to take medication despite the existence of contraindications. After the critical period, the medication should be stopped or reduced as soon as possible.

The use of glucocorticoids in children and postmenopausal women can easily lead to osteoporosis and even spontaneous fractures. Protein, vitamin D and calcium salts can be supplemented. Glucocorticoids can accelerate the elimination of salicylates and reduce their efficacy. The combined use of the two drugs can increase the risk of peptic ulcers. When combined with cardiac glycosides and diuretics, attention should be paid to potassium supplementation.

Hepatic drug enzyme inducers such as phenobarbital and phenytoin can accelerate the metabolism of glucocorticoids, and the dosage needs to be adjusted when used together. Corticosteroids can increase blood glucose and therefore reduce the effectiveness of oral hypoglycemic agents or insulin. Glucocorticoids can reduce the effect of oral anticoagulants, and the dose of anticoagulants needs to be increased when the two drugs are used together.

How Does Cistanche Treat Kidney Disease?

Cistanche is a traditional Chinese herbal medicine used for centuries to treat various health conditions, including kidney disease. It is derived from the dried stems of Cistanche deserticola, a plant native to the deserts of China and Mongolia. The main active components of cistanche are phenylethanoid glycosides, echinacoside, and acteoside, which have been found to have beneficial effects on kidney health.

Kidney disease, also known as renal disease, refers to a condition in which the kidneys are not functioning properly. This can result in a buildup of waste products and toxins in the body, leading to various symptoms and complications. Cistanche may help treat kidney disease ase through several mechanisms.

Firstly, cistanche has been found to have diuretic properties, meaning it can increase urine production and help eliminate waste products from the body. This can help relieve the burden on the kidneys and prevent the buildup of toxins. By promoting diuresis, cistanche may also help Reduce high blood pressure, a common complication of kidney disease.

Moreover, cistanche has been shown to have antioxidant effects. Oxidative stress, caused by an imbalance between the production of free radicals and the body's antioxidant defenses, plays a key role in the progression of kidney disease. ies help neutralize free radicals and reduce Oxidative stress, thereby protecting the kidneys from damage. The phenylethanoid glycosides found in cistanche have been particularly effective in scavenging free radicals and inhibiting lipid peroxidation.

Additionally, cistanche has been found to have anti-inflammatory effects. Inflammation is another key factor in the development and progression of kidney disease. Cistanche's anti-inflammatory properties help reduce the production of pro-inflammatory cytokines and inhibit the activation of inflammation mandatory pathways, thus alleviating inflammation in the kidneys.

Furthermore, cistanche has been shown to have immunomodulatory effects. In kidney disease, the immune system can be dysregulated, leading to excessive inflammation and tissue damage. Cistanche helps regulate the immune response by modulating the production and activity of immune cells, such as T cells and macrophages. This immune regulation helps reduce inflammation and prevent further damage to the kidneys.

Moreover, cistanche has been found to improve renal function by promoting the regeneration of renal tubes with cells. Renal tubular epithelial cells play a crucial role in the filtration and reabsorption of waste products and electrolytes. In kidney disease, these cells can be damaged, leading to damaged renal function. Cistanche's ability to promote the regeneration of these cells helps restore proper renal function and improve overall kidney health.

In addition to these direct effects on the kidneys, cistanche has been found to have beneficial effects on other organs and systems in the body. This holistic approach to health is particularly important in kidney disease, as the condition often affects multiple organs and systems. che has been shown to have protective effects on the liver, heart, and blood vessels, which are commonly affected by kidney disease. By promoting the health of these organs, cistanche helps improve overall kidney function and prevent further complications.

In conclusion, cistanche is a traditional Chinese herbal medicine used for centuries to treat kidney disease. Its active components have diuretic, antioxidant, anti-inflammatory, immunomodulatory, and regenerative effects, which help improve renal function and protect the kidneys from further damage. , cistanche has beneficial effects on other organs and systems, making it a holistic approach to treating kidney disease.