A Clinical Observation Of Calcineur In Inhibitors Combined With Traditional Chinese Medicine In The Treatment Of 28 Refractory Nephrotic Syndrome

ObjectiveIn order to study the efficacy and safety of traditional Chinese medicine (TCM) combine with calcineurin inhibitors (CNI) in the treatment of refractory nephrotic syndrome (RNS), providing clinical evidence of Combined Treatment.MethodsUsing retrospective method analysis the 28 patients diagnosed as refractory nephrotic syndrome and treat with TCM and CNI at Traditional Chinese Medicine Hospital of Guangdong Province during January 2012 and September 2015. The course of treatment of TCM and CNI should longer than 6 months. We record the baseline character of the patients such as age, course, and nephrotic pathology.24 hours Urine protein, routine urine should be observed when the patients take the CNI in the 1st week,4th week,8th week,12th week,16th week,20th week,24th week. Also creatinine, albumin, cholesterol, triglycerides (TG) will be observed at the beginning and the end of the observation. In the end, analysis the release and the relapses of the 28 patients.ResultsAmong the 28 patients,21 men and 7 women among the 28 patients with age from 14 to 73 years old and the average age is (29.93±16.04); the disease duration is from 3 months to 132 months, average (41.04±39.27) months. Among the 28 patients 12 of them are glucocorticoids resistance and 16 of them are glucocorticoids dependent, none of them are frequency relapses.26 Of 28 cases had a for nephrotic pathology, among 11 cases (39.3%) as Minimal Change Disease (MCD),10 cases (36%) as Membranous Nephropathy (MN),2 cases (7.1%) as Mesangial Proliferative Glomerulonephritis (MsPGN),2 cases (7.1%) as glomerular minor lesion, 1 case (3.6%) as the Focal Segmental Sclerosing Glomerulonephritis (FSGS). In terms of previous treatment,28 patients, all of them used glucocorticoids treatment,7 patients once used glucocorticoids combined cyclophosphamide therapy, and 4 patients used glucocorticoids combined mycophenolate mofetil. In terms of efficacy,71.43% patients got complete remission,17.86% patients only get partial remission, all in all the total effective rate is 89.29%. The 24 hours urinary protein decrease significantly after the treatment and blood lipids, blood albumin and other biochemical indicators improved significantly. Baseline data analysis found that MCD patients seems easier to achieve complete remission, and MN patients achieved complete remission is relatively difficult. At the same time, the glucocorticoids dependent patients are more likely to achieve complete remission than glucocorticoids resistant patients. Follow-up tracking, found that 10 patients were relapsed,70% of them were relapse after drug withdrawal, In 18 patients with remission, 88.89% of them maintain with low dose CNI, only 2 (11.11%) patients stop drugs. In terms of traditional Chinese medicine, the most common syndrome is blood stasis (42.9%).24 weeks after the treatment the most common and certificate for damp heat syndrome (42.9%). This study found no correlation between TCM syndromes and prognosis.ConclusionRefractory nephrotic syndrome treated with CNI combined with glucocorticoid seems to be fast to achieve remission with high remission rate. There is no difference between the glucocorticoids resistance and glucocorticoids dependent in the field of remission. But at the same time, the patient diagnosis as MN is more likely to have lower complete remission rate than any other pathology. The patient keep with low dose CNI have lower relapse rate than drug withdrawal one. Spleen and kidney deficiency of Qi and blood stasis is the most common syndrome of TCM in the Refractory nephrotic syndrome.