The Journal of Pediatrics of Korean Medicine (대한한방소아과학회지)

The Association of Korean Oriental Pediatrics (대한한방소아과학회)
권호 표지
DOI QR코드

DOI QR Code

Review of Clinical Research for Herbal Medicine Treatment on Refractory Nephrotic Syndrome in Children

소아의 난치성 신증후군의 한약 치료에 대한 최신 임상연구 동향

  • Jang, Eun Ha (Department of Pediatrics, Dongguk University Bundang Oriental Hospital) ;
  • Min, Sang Yeon (Department of Pediatrics, Dongguk University Ilsan Oriental Hospital) ;
  • Kim, Jang Hyun (Department of Pediatrics, Dongguk University Bundang Oriental Hospital)
  • 장은하 (동국대학교 분당한방병원 한방소아과) ;
  • 민상연 (동국대학교 일산한방병원 한방소아과) ;
  • 김장현 (동국대학교 분당한방병원 한방소아과)
  • Received : 2020.07.02
  • Accepted : 2020.08.24
  • Published : 2020.08.31
Download PDF
⟨ Previous Next ⟩

Abstract

Objectives The purpose of this study is to analyze clinical studies on effectiveness of herbal medicine in refractory nephrotic syndrome (RNS). Methods We searched the randomized controlled trials (RCTs) with herbal medicine treatment on RNS from the Pubmed, CNKI, OASIS, NDSL, J-stage, and CiNii. The demographic data, duration of illness, intervention, treatment period, outcome, adverse events, and composition of herbal medicine were analyzed for this study. Results 11 RCT studies were selected and analyzed. The children in the control group were given western medicine therapy, and the treatment group was given herbal medicine along with the same western medicine of the control group. The most commonly used herbal medicines were the prescriptions to treat 'Kidney Deficiency with Blood Stasis (腎虛兼瘀血)' which composed of 'Promoting blood circulation (化瘀)', 'Diuresis-inducing (利水)', or 'Heating Yang (溫陽)' medicine based on 'Replenishing Kidney or Spleen (補腎, 補脾)' medicine. In the treatment group, proteinuria and serum lipid was significantly decreased, serum albumin was significantly increased, and total effective rate was significantly higher than the control group. Hypercoagulation and relapse rate was also significantly reduced. Adverse events were significantly lower in the treatment group. Conclusions Herbal medicine treatment on pediatric RNS can be suggested as a new treatment for children who have less response to the conventional therapy. It can also supplement the limitations of the western medicine by reducing adverse events from the steroids and immuno-suppressive agents, and lower the relapse rate as well.

Keywords

References

  1. A. A. Eddy, J. M. Symons. Nephrotic syndrome in childhood. The Lancet. 2003;362(9384):629-39. https://doi.org/10.1016/S0140-6736(03)14184-0
  2. International study of kidney disease in Children. Nephrotic syndrome in children: prediction of histopathology from clinical and laboratory characteristics at time of diagnosis. Kidney Int. 1978;13(1):159-65. https://doi.org/10.1038/ki.1978.23
  3. Ko KW, Ha IS, Jin DK, Cheong HI, Choi Y, Kim YI, Lee HS. Childhood renal diseases in Korea: A clinicopathological study of 657cases. Pediatr Nephrol. 1987;1(1):664-9. https://doi.org/10.1007/BF00853605
  4. R. K. Chandra. Refractory nephrotic syndrome. Nihon Rinsho. 2004;62(10):1794-9.
  5. K. L. Gibson, P. Hansrivijit, M. E. Ferris. Emerging Agents for the Management of Nephrotic Syndrome: Progress to Date. Pediatric Drugs. 2016;18(1):25-9. https://doi.org/10.1007/s40272-015-0148-y
  6. Koskimies O, Vilska J, Rapola J, Hallman N. Long-term outcome of primary nephrotic syndrome. Arch Dis Child. 19;57(2):544-8. https://doi.org/10.1136/adc.57.7.544
  7. Spitzer A, Gordillo G, Houston IB, Travis LB. A report of international study of kidney disease in children: prospective, controlled trial of cyclophosphamide therapy in children with the nephrotic syndrome. Lancet. 1974;2(1):423-7.
  8. Waldo FB, Benfield MR, Kohaut EC. Methylprednisolone treatment of patients with steroid resistant nephrotic syndrome. Pediatr Nephrol. 1992;6(2):503-5. https://doi.org/10.1007/BF00866483
  9. Cattran DC, Alexopoulos E, Heering P. Cyclosporin in idiopathic glomerular disease associated with the nephrotic syndrome : workshop recommendations. Kidney Int. 2007;72(12):1429-47. https://doi.org/10.1038/sj.ki.5002553
  10. Garin EH, Orak JK, Hiott KL et al. Cyclosporine therapy for steroid resistant nephrotic syndrome. A controlled study. Am J Dis Child 1988;142(3):985-8.
  11. Lieberman KV, Tejani A. A randomized double-blind placebo-controlled trial of cyclosporine in steroid-resistant idiopathic focal segmental glomerulosclerosis in children. J Am Soc Nephrol. 1996;7(1):56-63. https://doi.org/10.1681/ASN.V7156
  12. Ponticelli C, Rizzoni G, Edefonti A et al. A randomized trial of cyclosporine in steroid-resistant idiopathic nephrotic syndrome. Kidney Int 1993;43(4):1377-84. https://doi.org/10.1038/ki.1993.194
  13. El-Husseini A, El-Basuony F, Mahmoud I et al. Long-term effects of cyclosporine in children with idiopathic nephrotic syndrome: a single-centre experience. Nephrol Dial Transplant. 2005;20(11):2433-8. https://doi.org/10.1093/ndt/gfi059
  14. V. D. B. Ja, P. R. van Dijk, J. M. Hofstra, J. F. Wetzels. Long term outcomes in idiopathic membranous nephropathy using a restrictive treatment strategy. J Am Soc Nephrol. 2014;25(1):150-8. https://doi.org/10.1681/ASN.2013020185
  15. Kim KB, Kim DG, Kim YH, Kim JH, Min SY, Park EJ, Baek JH, Sun HK, Yu SA, Lee SY, Lee JY, Chang GT, Jeong MJ, Chai JW, Cheon JH, Han YJ, Han JK. Hanbangsoacheongsonyeonuihak (ha). Seoul; Eui Sung Dang Publishing Co. 2015:184-6.
  16. Wang XQ, Wang L, Tu YC, Zhang YC. Traditional chinese medicine for refractory nephrotic syndrome: strategies and promising treatments. Evid Based Complement Alternat Med. 2018:1-11.
  17. Xu G, Tu WP, Jiang DF, Xu CG. Tripterygium wilfordii Hook F treatment for idiopathic refractory nephrotic syndrome in adults: a meta-analysis. Nephron Clin Pract 2009;111(1):223-8.
  18. Kim DH, Joe CS, Kim CJ. A clinical case report of nephrotic syndrome. J Daejeon Univ. Korean Med. 2005;14(2):1-4.
  19. Ahn YM, Ahn SY, Doo HK. The Immuno-regulatory effects of Onbi-tang and Dangguijakyak-san in minimal change nephrotic syndrome. J Korean med. 2000;21(1):20-8.
  20. Lee MG, Ahn SY, Doo HK. The Immuno-regulatory effects of Chungsimyeunjaeum and Daebunchungeum in minimal change nephrotic syndrome. J Kyunghee Univ. 2000;23(1):51-70.
  21. Wei L, Liu C. Clinical study of primary refractory nephrotic syndrome in children treated by Wenyang-lishui-huayu therapy. Chin J Inf Trad Chin Med. 2019;36(5):66-70.
  22. Xia SQ, Li N, Yang GH. Thirty-nine cases of refractory nephrotic syndrome in children treated with Bao shenxiao- zhuo decoction. Henan Trad Chin Med. 2018;38(10):1552-4.
  23. Wang XH. Observe the curative effect of refractory nephrotic syndrome of children in treatment with chinese medicine. Chinese Health Standard Management. 2015;6(8):74-5.
  24. Lu SK. Treatment of Canlingbaishusan jiajian(蔘苓白朮散 加減) on refractory nephropathy in children. Henan Trad Chin Med. 2014;34(9):1765-6.
  25. Li DL. Study of effects of TCM combined treatment on refractory nephritic syndrome in children. Chin J Med Guide. 2013;15(9):1465-6.
  26. Zheng J, Chen N. Ai S. Effect of Shenkangling Decoction on Neuropetide Y in Frequent Relase Nehritic Syndrome in Children. J Trad Chin Med. 2012;53(9):755-7.
  27. Zheng J, Zhuang XZ, Ai S. Intervention effect of Shenkangling on lipoprotein a in children with frequent relapse nephrotic syndrome. JFUTCM. 2010;20(4):4-6.
  28. Zheng J, Chu KD, Lin Q. Clinical research on Shenkangling decoction in treating 30 children with frequent relapse nephrotic syndrome. JFUTCM. 2010;19(2):1-3.
  29. Ai S. The clinical research on $NF-{\kappa}B$, TXB2, $6-keto-PGF1{\alpha}$ in children with FRNS by treatment of decoction Shenkangling by tonifying the kindey and promoting blood circulation. {master's thesis}: Fujian University of Traditional Chinese Medicine; 2008. 36p.
  30. Wei JH. The clinical research on children with FRNS by treatment of decoction Shenkangling and cortisol, TXA2, PGI2. {master's thesis}: Fujian University of Traditional Chinese Medicine; 2006.
  31. Wu LQ, Ding Y. 53 Clinical observation on children's refractory nephrotic syndrome treated with Yiqi-Zishen- Huoxue-Fang 75Cases. JSCTCM. 2002;3(3):20-2.
  32. Chinese medical association of pediatrics nephrology. Child hormone sensitivity, relapse/nephropathy-dependent syndrome evidence-based guidelines for diagnosis and treatment (兒童激素敏感反復/依存腎病綜合證診治循症指南). Chin J Pediatr. 2017;10(55):729-34.
  33. Borel JF. Mechanism of action of cyclosporin A and rationale for use in nephrotic syndrome. Clin Nephrol. 1991;35(1):23-30.
  34. Heo J. Donguibogam. Seoul: Beob In Publishing Co. 2012:898.
  35. Wang XQ, Wang CJ, Yuan J. Immune glomerular diseases difficulties and Chinese medicine treatment strategies. Chin J Integr Trad West Nephr. 2010;11(2):169-71. https://doi.org/10.3969/j.issn.1009-587X.2010.02.035
  36. Wang XQ, Wang L, Tu YC. Traditional chinese medicine for refractory nephrotic syndrome: strategies and promising treatments. Evid Based Complement Altern Med. 2018;(1):1-11.
  37. Chinese Medicine Association. Guidelines for the diagnosis and treatment of common diseases in chinese medicine pediatrics. Beijing: China Traditional Chinese Medicine Press. 2012:40-77.
  38. State Administration of Traditional Chinese Medicine. Diagnostic and therapeutic criteria for TCM syndromes. Beijing: China Medical Science and Technology Press. 2012:278-99.
  39. Norma A, Anrhony PF, Manoj N, Alan MR. Course and resolution of the coagulopathy in nephrotic children. Kidney Int. 1987;31(1):772. https://doi.org/10.1038/ki.1987.65
  40. Wu QH, Yan LP, Wang NJ, Zhen Z, Liu SZ, Zhang WZ. Clinical study of Sijunzi decoction and Liuwei dihuang decoction for chronic nephritis with Qi and Yin deficiency pattern. Progress in Modern Biomedicine. 2016;16(36):7113-6.
  41. Nie JT. Efficacy of fangjihuangqi decoction in treatment of patients with primary nephrotic syndrome in edema period and its influence on 24hr urinary protein, serum albumin and lipid. Clinical J Chin Med Pract. 2017;21(1):48-51.
  42. Han L, Deng YY, Chen YP. Clinical therapeutic research of idiopathic membranous nephropathy by YiqiHuoxue Huashi Project and analysis of correlative influencing factors. Chin J Integr Trad West Nephr. 2010;11(1):879-83.
  43. Leehey DJ, Casini T, Massey D. Remission of membranous nephropathy after therapy with astragalus membranaceus. Am J Kidney Dis. 2010;55(4):772. https://doi.org/10.1053/j.ajkd.2010.01.012
  44. Ahmed MS, Hou HS, Battaglia MC, Picken MM, Leehey DJ. Treatment of idiopathic membranous nephropathy with the herb Astragalus membranaceus. Am J Kidney Dis. 2007;50(6):1028-32. https://doi.org/10.1053/j.ajkd.2007.07.032
  45. Shi JF, Zhu HW, Zhang C, Bian F, Shan PJ, Lu W. Therapeutic effect of Astragalus in patients with chronic glomerulonephritis. Acta Univ Medicinalis Secondae Shanghai. 2002;22(3):245-47. https://doi.org/10.3969/j.issn.1674-8115.2002.03.016
  46. Wang YJ, He LQ, Sun W, Lu Y, Wang XQ. Optimized project of traditional Chinese medicine in treating chronic kidney disease stage 3: a multicenter double-blinded randomized controlled trial. Journal of Ethnopharmacology. 2012;139(3):757-64. https://doi.org/10.1016/j.jep.2011.12.009
  47. Chen XR. Clinical observation on curative effect of primary nephrotic syndrome treated with JiaweiFangji HuangqiTang and its effects on serum IL-10 and TNF-${\alpha}$. Trad Chin Med Technology. 2016;23(4):393-5.
  48. Cao GH, Liu CH, Zhang XF. Clinical Study on Fangji Huangqi Decoction Treatment of Children with Nephrotic Syndrome. Acta Chin Med. 2017;32(10):2009-12.
  49. Hao M. Professor Yang Shuo-ping plus-minus against oneself Huang Qi Tang intreatment of nephrotic syndrome (Feng Shui-combination) clinical observation of 46 cases. Clinical J Chin Med. 2014;30(6):68-70.
  50. Herbology Editorial Committee of Korean Medicine schools. Boncho-hak. Seoul:Young-Lim Press. 2004:418-9.