Study of Drug Therapy of Children Refractory Nephrotic Syndrome

Objective To study and compare the therapeutic effects with three different therapeutic methods on children with refractory nephrotic syndrome (RNS), and to analyze which method is the best in treating children RNS. Methods Altogether 110 cases were randomly divided into three groups of A, B and C. The patients in group A received prednisone alone, group B received prednisone combined with CTX, and group C received combined prednisone-CTX and additional PSS. The total therapeutic course of the three groups was 12 months. Results 1. The effective rates of group A, B and C were 20.7%, 65.7% and 91.3% respectively. The effective rates of both group B and group C were 40% higher than that of group A respectively (P0.01, P0.01). The effective rate of group C was higher than that of group B (P0.05). 2. The effective rates of frequent relapse cases in group A, B and C were 25.0%, 71.4% and 95.2% respectively; the effective rates of these cases in both group B and C were 40% higher than that of group A respectively (P0.05, P0.01); and the effective rate of group C was 20% higher than that of group B, and also showed significant difference. 3. The effective rates of the hormone-dependent cases in group A, B and C were 22.2%, 66.7% and 92.9% respectively, in which the effective rates of both group B and group C were 40% higher than that of group A respectively (P0.05, P0.01). 4. The effective rates of the patients which were drug-resistant in group A, B and C were 12.5%, 55.6% and 81.8% respectively. Furthermore, the effective rates of this type of patients in both group B and group C were 40% higher than that of group A respectively. 5. As to the different pathological type of the drug-resistant patients in these three groups, there were 6 NMCNS patients in group A who all had poor therapy effect; but the effective rates of the NMCNS patients in group B and group C were 50% and 80%, respectively. There was significant difference between group C and group A (P0.01), but there was no difference between group B and group A (P0.05). 6. The incidence rates of side effects in group A, B and C were 62.1% , 31.4% and 13.0% respectively; the incidence rates of side effects in both group B and group C were lower than that of group A respectively (P0.05, P0.05); and the incidence rate of side effects in group C was lower than that of group B (P0.05). As to the complete remission patients after stopping therapy for one year, the recurrence rates of group A, B and C were 50%(2/4), 20%(3/15) and 11.5%(3/26) respectively. Conclusions Prednisone combined with CTX has the better therapeutic effect than prednisone alone on children with RNS. Furthermore, using three kind of drugs involving prednisone, CTX and PSS simultaneously can significantly improve the outcome, including the therapeutic effect, the relapse rate and side effects.