The basic principle is that once children diagnosed with kidney disease
treatment should be used as soon as possible hormonal induction of remission and
good home care to prevent disease recurrence. However, due to long-term
high-dose steroid therapy prone to side effects, so treatment must be reasonable
under the guidance of specialists, to minimize side effects, so that children
with early rehabilitation. Hormone therapy requires attention to what the
problem?
One, before the amount should be enough
Hormone therapy efficacy and dose of nephrotic syndrome have a certain
relationship. Newly diagnosed cases, the initial stages of treatment should be
sought as soon as possible to induce urine protein was negative, the starting
dose should be large enough to induce rapid relief of symptoms. Hormone usually
prednisone, per person per day per kilogram of body weight of 1.5 to 2 mg orally
3 times (the maximum amount of not more than 60 milligrams per day).
Second, reduce the dosage to slow
To prevent recurrence after hormone therapy in children with urinary protein
was negative parents are not allowed to reduce the amount of hormones or
withdrawal, must gradually reduce the dose of hormones under the guidance of
kidney disease specialist. Usually after negative urine protein hormone therapy
continues to consolidate two weeks, generally a sufficient amount of not less
than four weeks, up to eight weeks. In the consolidation of the maintenance
phase, in order to reduce the side effects of drugs, may be two milligrams per
kilogram of body weight every other day approach to a Dayton clothing early in
the morning as well, continue to take four weeks, depending on urine recovery
tapering. General reduction every 2 to 4 weeks time, the reduction of 2.5 to 5
mg each, to prevent recurrence.
Third, maintain longer
Hormone therapy treatment has short, medium and long-range points. Short for
hormone therapy 8 weeks; mid-range for hormone therapy 4 to 6 months; hormone
therapy for long-range 9 to 12 months. Advantage of short-term therapy is less
hormonal side effects, the disadvantage is easy to relapse, domestic less. At
present, the commonly used long-term therapy, namely the maintenance of a
relatively long duration of treatment with hormones, the consolidation effect,
the advantage is less relapse, but more side effects.
Fourth, we must ground observation
During hormone therapy should pay attention to changes in urinary protein as
well as a daily urine, plasma protein recovery and so on. Because long-term use
of hormones prone to side effects, it should be closely observed, such as
changes in blood pressure, weight, body, etc., be alert to whether the
proliferation of latent infection and lesions. Prescribed replenish calcium to
avoid osteoporosis or tetany disease. Body changes due to drug-induced self
recovery after stopping, the family do not have misgivings. Should regularly go
to the hospital after discharge nephrology outpatient follow-up, review,
gradually decreasing the dose, do not arbitrarily sudden withdrawal. The longer
treatment time, decreasing speed should be slower in order to avoid
recurrence.
Fifth, to prevent recurrence
In the treatment of kidney disease process often prone to relapse, relapse
mainly infection, the most common infection is respiratory tract infections,
including pneumonia, followed by peritonitis, severe sepsis and even. Therefore,
the children do not go to crowded places, bedroom should be ventilated to
prevent cross-infection. Vaccination should be deferred to a variety of kidney
disease two years after complete remission.
For refractory nephrotic syndrome, such as hormone therapy drug (prednisone
regular treatment eight weeks invalid), frequent relapses (effective relapse
after initial treatment with prednisone two times within six months, or more
than three times a year relapse), hormones dependence (after steroid withdrawal
or reduction of recurrence within 14 days, and repeat 2 more times), available
intravenous cyclophosphamide pulse therapy, methylprednisolone pulse therapy,
cyclosporin A and anticoagulant therapy.
