The Investigation Of Treatment With Children Primary Nephrotic Syndrome Relapse

Objectives:Nephrotic syndrome is the frequent chronic illness of children, glucocorticoid is most effective way to cure. However, when people get remission after hoemone therapy, the relapse rate is more than50%. According to the guide of treatment of nephrotic syndrome, we need to use the prednisone of2mg/kg-d again to induce remission. In this way, the side factor will be increasing and the dependence of patient will be decreased. So we are trying to evaluate different treatment method and hope to find a method with similar effective but less side factors which could be easier acceptable by the patience.Methods:This is a retrospective, historical controlled study. Children admitted to Urology Department at children’s hospital, Zhejiang university school of medicine from January2009to june2010were eligible for this study.inclusin criteria:identify the diagnosis of nephrotic syndrome; sensitive of the hormone and relapsed during the decrement. All the children were given the general treatment including:taking rest; anti-infection; deal with the symptom. children who did not have been recurred will be treated as the follow ways:1. ACTH intravenous injection.2. to up-regulate hormone agent or to start hormone therapy again. But the hormone agent will be half of the sufficiently.3. hormone and other typologic of immunodepressent like CTX, MMF, FK-506, TG and etc., all the cases obtained the informant consent from the parents. We observe the curacive effect in the near future, and part of the kids were taken renal needle biopsy. The tissues were examined by light microscope, immunofluorescence and transmission electron microscope.Consequence:There were174cases matching conditions and had integrity data record, with125boys and49girls. Age of on-set0.6-13years old, average4.6years old. There were35cases relapsed after stop using hormoning, and139cases relapsed during the treatment.73cases were less than3years old at the age of onset.28cases released after general treatment, including complete remission27cases and partial remission1case.13cases were used ACTH to treat, and8cases found complete remission,3cases found partial remission,2cases found treatment failed. There were102cases up-regulated or started to use hormone again,88cases found complete remission,8cases found partial remission,4cases found treatment failed.39cases were treated with immunodepressent,19cases found complete remission,9cases found partial remission,11cases found treatment failed.32cases were taken renal needle biopsy, mainly of pathology type were minimal lesion, others including IgM nephrosis, mesangial proliferative nephritis, focal segmental glomerulosclerosis(FSGS).We analyse the clinic data between the team of general treatment useful or useless, treated with ACTH or with middling hormone, purely hormone treatment or therapeutic alliance, we find some difference of statistics.Conclusions:1. When nephrotic syndrome in children recurred,16.1%children can be relieved by general treatment. Nonresponder cured by intravenously guttae ACTH or by middling hormone dose, in which61.5%found remission. The two ways add to77.6%effective power. Middling hormone with one type of immunosuppressive agent can make16.1%cases released. The total effective power adds to93.7%.But we need to observe the curative effect further.2. Compared with the therapy of ACTH and middling hormone, we prefer to the therapeutic alliance in children who were littler than3years old, or relapsed during the treatment, or relived less than two weeks, or to show up hypoproteinemia at the beginning.