The Clinical Observation Of Short-term Effect Of Methyl Prednisolone Pulse Therapy In Treating Children With Primary Nephritic Syndrome

Objective: Nephrotic syndrome is the most common in pediatric kidneydisease, in addition to the acute nephrotis. Methyl prednisolone pulse therapyhas been widely applied in the treatment of refractory nephritic syndrome.The study aims to analyze the short-term effects of pulse therapy in the treatmentof nephritic syndrome, including its curative effect and adverse reactions, to guide clinical rational drug use, and to provide basis for treatment, better treatment and forecast the problems that Produced by the Methyl prednisolone pulsetherapy in treating children with primary nephrotic syndrome.Methods: Forty-one children (30boys and11girls, aged from1to10)with primary nephrotic syndrome are selected from October2012to December2013in Hebei Medical University second hospital pediatric kidney treatmentgroup, data was collected before treatment in children with24h urine protein quantity,24urine volume, weight, blood pressure, fasting plasma glucose, aftergiving methyl prednisolone sodium succinate15to30mg/kg (maximum1000mg),150-200ml, add5%glucose liquid in the quiescent point1to2hours, treatment for3days. Stop oral glucorticosteroid when shock treatment are going on, and continuing the dosage of glucocorticoid after the completion of treatment, other treatment drugs oral with former usage. The first day of collectingdata was the day of shock therapy, collected data from the first day to day14of24h urine protein quantity; Collected the24h urine volume, weight, and blood pressure on the second day, the third day, the fourth day, the fifth day, the seventh day, the ninth day,11days and14days of;collected fasting plasma glucose on the third day,7days and14days; the data of before middle after data of blood pressure were collected when the pulse therapy was used, at the same t ime monitoring adverse reactions such as gastrointestinal reaction, infection and others caused by glucocorticoid on the first day to two weeks. Blood pressure, blood glucose, body weight were both data collected by the same person under the same condition with the same experiment measuring instrument.Results:1In41cases, about75.6%of children with Urine protein disappear, numbers of days（8.58±2.321）2Fasting glucose has no obvious statistical significance (P>0.05)compared with before the Methyl prednisolone pulse therapy was used on the third day,onthe seventh day, and the14th day.3The difference of systolic blood pressure is statisticallysignificant (t=6.896,P=6.896) compared with before the Methyl prednisolone pulse on the third day. The blood pressure (114.05+7.473)on the third is higher compared withbefore treatment (106.93+9.241),the next day, the fourth day, the fifth day, the seventh day, the ninth day,11days,14days before the shock have no statistical significance (P>0.05).4The difference of body weight is statistically significant on the secondday (z=4.234,P=0.000), the third day (z=4.271,P=0.000), the fourth day (z=3.874, P=0.000)(P <0.05),25(13.5) on the second day, on the third day25(13.6) aresignificantly increased before treament24.5(13.1), and the fifth day, the seventh day, the ninth day,11days,14days than it was before the shock have no obvious statistical significance (P>0.05).5The difference of24h urine on the second day(z=4.643, P=0.000), thethirdday (z=3.779, P=0.000), the fifth day (z=3.318, P=0.001), and on the seventh day (z=3.109, P=0.003), the ninth day (z=2.959, P=0.003),11days(z=2.757, P=0.006),14days (z=3.830, P=3.830) have a significant statistical significance compared with before treatment(P<0.05), the second day,1300(663) and1400(725) three days is decreased before the impact1500(1125), the fifthday to day14are increased, the fourth day has no obvious statistical significance (P>0.05). 6The difference of24h urine protein on the second day (z=4.671, P=0.00),the third day (z=2.695, P=0.007), the fourth day (z=2.090, P=2.090), the fifth day (z=5.074, P=0.000), and on the seventh day (z=5.417, P=0.000), the ninth day (z=5.497, P=0.000),11days (z=5.498, P=0.000),14days (z=5.511,P=5.511) has obvious statistical significance (P<0.05) comparedwith before the shock, the second day of4.4(3.73),3.7(4.16) on the third daya significantly increased before treatment3.205(2.81),on the first day has nostatistical significance(P>0.05).7On the first day, the second day, systolic blood pressure of Before,middle and after of pulse therapy have no significant statistical difference (P <0.05), the third day before shock treatment (t=7.871,P=7.871), and after the shock treatment (t=7.542, P=7.542) have statistical significance (P<0.05), Systolic blood pressure,(113.00+8.305) among the impact is higher compare with before the treatment (108.13+7.318)，systolic blood pressure,(114.05+7.473)after the treatment is higher compare with before the treatment (108.13+7.318).8The study exists three children with upper respiratory tract infection in two weeks, one happens when strong shock treatment is going on, so therapy isdiscontinued, the other2patients in shock treatment is completed, give effective anti-infection treatment of symptoms, infection was controlled.1patient exists gastrointestinal reaction in shock treatment3days there characterized by nausea, giving cimetidine improvement after gastric mucosa protectant,3casesappeared in the process of blood pressure increased significantly more than130/90mmHg,2called shock therapy, the other one called shock treatment on the fourth day, the highest141/102mmHg, and blood pressure down to normal after administering nifedipine was given with sublingual.Conclusion:1Methyl prednisolone pulse therapy with nephritic syndrome have2days of urine protein increased period are the second day and three days, the urine protein of75.6%of children is disappear in （8.58±2.321）days. 2Fasting plasma glucose of Methyl prednisolone pulse therapy in treatment nephrotic syndrome has no obvious changes in two weeks, the short effectof treatment has no significant effect on fasting plasma glucose.3Treated with Methyl prednisolone pulse therapy on the second day andthreedays significantly reduced the volume of urine, weight gain, after into significant diuretic effect, increase urine output, reduce weight.4Treatment during the third day and the three days have a tendency toincrease systolic blood pressure, the fourth day to two weeks blood pressure haveno obvious statistical significance compare with before the treatment.5A strong shock treatment2weeks may appear adverse reactions such asinfection, gastrointestinal reaction, the birth rate of adverse reactions is14.6%.