Effects and Side Effects of Hormonal Therapy in Treating Minimal Change Disease

Conventional dose of hormone treatment: Prednisone 60mg/m2/d for children and 40~60mg/d for adults with a gradual decrement in 4 ~6 months. It will take effect in 4 weeks for 90% of children patients and in 8 weeks for 90% adults. If massive proteinuria still exists, immunosuppressant should be added to the treatment.
About 50% of those who are sensitive to hormone can maintain negative proteinuria or relapse after drug reduction or withdrawal, but most of the patients will finally remit. The other 50% of the patients often relapse or present hormonal dependence which means that larger dose of hormone is needed to control proteinuria. At this time, side effects of hormone often occur and are more obvious in children patients. Daily addition of Cyclophosphamide 2~3mg/kg (75mg/m2 for children) in the treatment for 8~12 weeks will prolong the paracmasia of patients who are sensitive to hormone. Because of the toxicity to gonad, teratology and other toxic reactions, cytotoxic drugs can only be applied when the kidney disease and side effects of hormone are both severe. In cases where hormone is effective but recurrent attacks are often or there is dependence to hormone, and moreover, there is no indicator for application of cytotoxic preparation Cyclophosphamide, Ciclosporin A can be applied in such cases. Orally taking Ciclosporin with a dose of 3.5~4mg/(kg·d), most patients with MCD can have remission of their symptoms. The there can be a significant reduction of hormone.
When Nephrotic Syndrome caused by MCD cannot remit through the above treatment, the following should be paid attention to:
(1) Control or remove the infection focus especially the latent infection focus.
(2) Renal venous thrombosis. Conduct CT in time and when there is renal venous thrombosis for final diagnosis, Urokinase of 40~80 thousand u/d adding to 0.9% Sodium Chloride 40ml can be used by intravenous injection 1~2 times/d. Early diagnosis of renal venous thrombosis and positive anticoagulant therapy can improve the condition of primary glomerulopathy and prognosis of various primary glomerulonephritis.
(3) Patients who are not sensitive to hormone often have focal glomeruloslcerosis.
(4) In order to reduce recurrence rate after withdrawal of hormone, concentration of blood Cortisone should be determined before withdrawal of hormone. Patients with normal concentration of blood Cortisone are not easy to relapse.