1 , the first stage of starting therapy (also called the induction phase ) hormone therapy nephrotic syndrome , was positively correlated with the dose . So began the first phase of the dose is large enough to make the disease as soon as possible to alleviate the general adult prednisone dose should be 1 mg / (kg · day ) , individual patients available to 1.5 mg / (kg · day ) . There are reports that 2 to 13 years old pediatric patients , the dose should be throwing pine 2 ~ 2.5 mg / (kg · day ) , the more the young age of the children , then poured the need for greater amount of pine . However, the daily dosage of hormones , not > 80 mg. If patients with impaired liver function , it is not appropriate to splash the loose , and should be changed to prednisolone , which is the same dose and throwing pine .
Treatment methods , it was considered to early morning serving Dayton as well, so you can make the exogenous hormones and physiological hormone fluctuations synchronization, you can significantly reduce the side effects of adrenal axis suppression , also suggested that in the beginning stages of hormone therapy , the 1st dose of 2 to 4 times daily , so that the plasma concentration is relatively stable , more effective than Dayton clothing , after the effect of hormones needed reductions , and then to Dayton clothing . This is a common clinical problem, benevolent see benevolence and the wise see wisdom , and now there is no evidence -based medicine . I think it should vary if the day taking hormone doses greater than 60mg, can be divided doses , if less than 60mg, Dayton clothing can be considered in the morning to reduce the side effects of hormones. Children's use of large doses of hormones , the initial stages of treatment should also be daily dose divided doses.
2 , reduction treatment phase usually with large doses of hormones after eight weeks required reductions , reduce the dosage of the progressive reduction, reduction of 5% -10 % of the original dose every two weeks . To adhere to the same dose of the smaller , slower speed reduction principles . Note that during this period are:
If after 8 weeks of high-dose therapy did not improve, or even worse, at the same time careful to exclude the existence of factors that affect the efficacy of such infections , it is estimated to continue medication will not be effective ( hormone invalid type ) , the dose should be rapidly reduced to short-term disabling , if the conditions , it is best to send a higher level hospital for biopsy .
If the treatment of nephrotic syndrome after partial remission ( proteinuria <3 g / day or more has been reduced by more than half , edema and other symptoms have abated ) , then reduced to a small dose of hormone withdrawal ( for adults and 0.5 mg / (kg · day ) , children of 1 mg / (kg · day ) ] , to a two-day administration , that the next day early morning serving Dayton .
If given large doses of hormones, the patient's condition or less than six weeks will soon get relief, consolidation may ease after two weeks with the original dose , the reduction can be carried out . Such as minimal change nephropathy , 90% of pediatric patients in complete remission after four weeks , it usually take four weeks , then take two weeks , you can enter the reduction stage. Remission in adult patients is slow , often requires the use of hormones eight weeks , in order to identify the patients with nephrotic syndrome hormone is valid . Hormone treatment generally should not be more than three months, increase the dose of hormones and prolonged treatment should be cautious. After the withdrawal of a small dose reduced , depending on the particular circumstances, for longer-term continuous therapy or continued reductions , adverse reactions hormones would be greatly reduced. Dose reduction must be stressed very slow manner, should at least experience a month or more .
3 , continued treatment phase began after the first high-dose hormone therapy , remission only in part , by the above method reductions to small doses ( adult every other day to 1 mg / (kg · day ) , children every other day for the 2 ~ 2.5 mg / (kg · day ) , can take six months or longer , usually with a small dose of this hormone , the adverse reactions not ; If patients continued treatment in small doses , achieved complete remission , is in remission , according to the original amount then served four weeks , and then , very slowly and regularly reductions , while maintaining the reduced amount, depending on the specific circumstances of the patient , after a period of time with a maintenance dose , and then gradually tapered to discontinuation.
Hormone-sensitive , and rapid access to complete remission of cases , usually according to the above reduction to a maintenance dose of hormones , namely prednisone every other day morning service 0.4 mg / kg, this is the physical requirements , there are few adverse reactions , some clothes 4 months or longer time, and then very slowly and eventually to stop taking reductions .
Although some patients starting treatment for the first complete remission , but the short term ( < 6 months ) relapse, the dose is reduced to a certain extent even that recurrence ( ie, hormone-dependent ) , you can re- use of hormone therapy , and subject to the above conventional hormone dose reduction to maintain continuous treatment, sustainable medication 12 to 18 months.
4 , medication attention
1 ) the use of hormones must be under the guidance of the physician , the patient must not be allowed to decide their own course of hormone therapy or dose . Because the law does not apply steroids - random subtraction , withdrawal, withdrawal irregular cut , etc. , can easily accelerate the process of renal fibrosis , making repeated illness or worse, and repeated illness aggravated once again , increasing the difficulty of treatment.
2 ) Long-term use of hormones can lead to adrenal cortical atrophy , if a sudden reduction or abrupt withdrawal , the body can be caused due to lack of hormones adrenal crisis , high fever ( temperature over 40 ℃), nausea , vomiting, decreased blood pressure , etc. can occur in severe shock , so patients can not be arbitrarily withdrawal.
3 ) Long-term use of hormones, can cause a range of adverse reactions, such as lead cortex hyperfunction syndrome , peptic ulcer , hypertension, arteriosclerosis , osteoporosis and other diseases, so patients during treatment requires regular review , as happened these adverse reactions should be treated promptly .
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