How To Use Commonly Used Hormones in Nephrology?

The hormone drugs we usually refer to generally refer to adrenal cortex hormones. Adrenal corticosteroids are synthesized and secreted by the adrenal cortex and can be divided into three categories: mineralocorticoids, glucocorticoids, and sex hormones. Glucocorticoids mainly regulate glycoprotein and fat metabolism, and have pharmacological effects such as anti-inflammation and immunosuppression; mineralocorticoids mainly affect water and salt metabolism; sex hormones mainly 

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China is an area with a high incidence of kidney disease. According to the epidemiological survey and statistics of chronic kidney disease (CKD) and renal dysfunction, there are more than 130 million CKD patients in my country [1]. In the field of nephrology medication, hormones are an indispensable part. Mineralocorticoids and glucocorticoids are usually used. There are about 14 commonly used drugs, such as hydrocortisone, cortisone acetate, and prednisolone. Songlong et al.

Clinically, hormones should be selected according to the patient's condition and disease type. Let's take a look at which hormones can be used in nephrology, how to apply hormones, and learn about the precautions for using these hormones.

According to the disease type, the rational use of hormones

nephrotic syndrome

The most obvious feature of nephrotic syndrome is proteinuria, and it is a large amount of proteinuria (≥3.5g/d or 3.5g/1.73m2/24h), due to a large loss of protein, secondary hypoalbuminemia (≤ 30g/L) and edema. Depending on the pathological type of nephrotic syndrome, the application of glucocorticoids is also different, which can be divided into the following categories:

minimal change disease

Pediatric patients: It is recommended to take prednisone (Dragon) 60mg/m2/d orally (no more than 80 mg/d). After the urine protein turns negative, change to prednisone (Drone) 40mg/m2 every other day, usually for 8 weeks. Adult patients: The initial dose is prednisone (Drone) 1mg/kg/d (the maximum dose does not exceed 80mg/d), and after complete remission, start reducing the maintenance treatment, reducing 5%~10 of the original dose every 2 weeks %, and give 5-10mg daily or every other day, or use methylprednisolone 4-8mg to maintain treatment for a long time before stopping the drug.

focal segmental glomerulosclerosis

Focal segmental glomerulosclerosis needs to use a sufficient amount of glucocorticoid (1 mg/kg/d or 60 mg/d) for 3 to 4 months. If there is no obvious improvement after application for more than 6 months, there is glucocorticoid Hormone resistance.

Membranous nephropathy:

The dose of glucocorticoids for patients with membranous nephropathy is prednisone (Lone) 0.5-1 mg/kg/d. If complete or partial remission is achieved after treatment, the dose of glucocorticoids should be reduced and maintained as appropriate, and the total course of treatment should be at least 6-12 months.

IgA nephropathy:

For patients with IgA nephropathy whose urine protein quantity is less than 1.0g/24h, there is not enough evidence to show that glucocorticoid therapy is effective; patients with urine protein quantity between 1.0-3.5g/24h can be treated with glucocorticoid or combined with immunosuppressants, the usage is prednisone (Drone) 0.5~1.0mg/k/d, gradually reduce the dose after 6~8 weeks, and reduce to 5~10mg every day or every other day to maintain, the total course of treatment is 6 months or more [2].

crescentic nephritis

Crescentic nephritis is the most serious type of glomerulonephritis, clinically manifested as oliguric or anuric renal failure. For patients with cellular crescentic nephritis, methylprednisolone (500-800 mg/d, continuous for 3-5 days) was given during the induction period, followed by prednisone (Drone) 1 mg/kg/d for 4 days. Gradually reduce the dose after ~8 weeks; generally enter the maintenance period after 6 months, and reduce the dose to prednisone (Drone) 5~15 mg per day or every other day for maintenance treatment. For severe patients, methylprednisolone shock (500 mg/d, continuously applied for 3 to 5 days) can be given.

lupus nephritis

Lupus nephritis refers to renal damage complicated by systemic lupus erythematosus, and its pathological types are divided into mild lesion type (type Ⅰ), mesangial hyperplasia type (type Ⅱ), focal hyperplasia type (type Ⅲ), diffuse hyperplasia type (type Ⅳ), Membrane type (V type), sclerosis type (Ⅵ type), mainly treated with oral glucocorticoids. For patients with type, I and type II proteinuria, moderate doses of glucocorticoids can be given. For type III and type IV patients, prednisone (Lone) 1mg/kg/d can be given. If type III responds well, the dose can be reduced to daily or every other day prednisone (Lone) 5~10mg for maintenance treatment. Type VI Combined immunosuppressive therapy.

 interstitial nephritis

Including idiopathic interstitial nephritis, Sjogren's syndrome,e and interstitial nephritis caused by drugs. Idiopathic acute interstitial nephritis: Prednisone (Drone) 1 mg/kg/d can be given, gradually reduce and maintain treatment after 2 to 4 weeks when the condition improves; Interstitial nephritis caused by drugs and other factors: It is necessary to stop using drugs that may cause kidney damage first. If the renal function is significantly impaired, prednisone (Drone) 0.5~1.0mg/kg/d can be used for treatment. After the condition improves, it can decrease.

Intermediate-acting hormones commonly used in nephrology

After reading about the above diseases and medications, we can probably understand that intermediate-acting hormones such as prednisone and methylprednisolone are mainly used for the treatment of autoimmune kidney disease. Prednisone and prednisolone are different forms of the same drug, and prednisone is metabolized in the body to form prednisolone.

What are the side effects of long-term steroid use?

Long-term use of hormone drugs can cause adverse reactions, and the degree of adverse reactions is directly proportional to the dosage and time of the drug. The adverse reactions mainly include the following:

1. Iatrogenic Cushing's syndrome: such as central obesity, full moon face, skin purple ecchymosis, steroid-induced diabetes (or exacerbated by existing diabetes), osteoporosis, spontaneous fracture or even osteonecrosis (such as femoral head without Bacterial necrosis), female hirsutism, menstrual disorders or amenorrhea infertility, male impotence, bleeding tendency, etc.

2. Induce or aggravate various infections such as bacteria, viruses, and fungi.

3. Induce or aggravate gastroduodenal ulcer, and even cause massive bleeding or perforation of the digestive tract.

4. Hypertension, congestive heart failure, atherosclerosis, and thrombosis.

5. Hyperlipidemia, especially hypertriglyceridemia.

6. Muscle weakness, muscle atrophy, slow wound healing.

7. Steroid-induced glaucoma and steroid-induced cataract.

8. Mental symptoms such as anxiety, excitement, euphoria or depression, insomnia, and personality changes can induce mental disorders and seizures in severe cases.

9. Long-term application of children affects growth and development.

10. Long-term external use of glucocorticoids may cause local skin atrophy and thing, telangiectasia, pigmentation, secondary infection,n and other adverse reactions; long-term external use on the face may cause perioral dermatitis, rosacea-like skin lesions, etc.

11. Adverse reactions of inhaled glucocorticoids include hoarseness, throat discomfort, candida colonization, and infection. Systemic adverse reactions may also occur in long-term use of larger doses of inhaled glucocorticoids.