Chinese Herbal Injections for Primary Nephrotic Syndrome in Adults: A Systematic Review and Network Meta‐Analysis

Abstract

Primary nephrotic syndrome (PNS) is a common renal disease that presents with heavy proteinuria and hypoalbuminemia. Despite notable advances in its treatment, some patients show poor responses and clinical outcomes when treated with conventional Western medicine (WM). Chinese herbal injections (CHIs) have been reported to have beneficial effects for PNS. The aim of the present study was to comprehensively determine the efficacy and safety of CHIs for PNS in adults using a network meta-analysis approach. PubMed, Embase, the Cochrane library, and four Chinese databases were systematically searched to identify randomized controlled trials (RCTs) using CHIs for treatment of PNS published before June 1, 2019. Quality assessment of the identified RCTs was performed according to the Cochrane Handbook. Pooled odds ratios (OR) or mean differences (MD) with corresponding 95% confidence intervals (CI) were calculated for discrete or continuous variables, respectively. The primary outcome was complete/total remission and secondary outcomes were serum albumin and urinary protein excretion. The surface under the cumulative ranking curve (SUCRA) value and cluster analyses were used to rank treatment by probability. Eighty-five studies involving 11 CHIs and 5801 subjects were included. Compared with WM alone, CHI plus WM showed an improved complete/total remission rate as well as higher serum albumin and lower 24-hour urinary protein excretion, except in the following: Yinxingye injection plus WM did not improve the total remission rate, and Dengzhanhua or Xueshuantong injection plus WM did not lower the 24-hour urinary protein excretion. Either Danhong (DH) or Dengzhanhua (DZH) injection plus WM was the preferable treatment for PNS based on SUCRA and cluster analyses of clinical remission and adverse events. However, considering that literature in this area is limited, these results need further validation. CHIs administered as adjuvants to WM showed favourable outcomes for PNS. DH + WM and DZH + WM might be the potential optimal therapies for PNS.

A meta-analysis of the clinical efficacy and safety of Bailing capsules in the treatment of nephrotic syndrome

“…Besides, the clinical treatment of NS is mainly based on suppressing the immune inflammation. The use of renin-angiotensin blockers and/ or immunosuppressants has been recommended; through inhibiting aldosterone and antidiuretic hormone secretion, altering the permeability of the glomerular basement membrane, and exerting other comprehensive effects, these drugs support diuresis and the elimination of protein in urine (3). However, the long-term use of hormone-based therapies can easily lead to complications such as secondary infection, thromboembolism, or aseptic necrosis of the femoral head, which reduce the quality of life of the patient (4).…”

“…In recent years, Chinese medicines and Chinese patent medicines have gradually drawn attention as adjuvant treatments for NS patients (3). It has been reported that traditional Chinese medicine, acupuncture, acupoint injection combined with prednisone in the treatment of NS has a good efficacy.…”