The Efficacy and Safety of Glutamine Combined with Prednisone Acetate in the Treatment of Children with Primary Nephrotic Syndrome

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The Efficacy and Safety of Glutamine Combined with Prednisone Acetate in the Treatment of Children with Primary Nephrotic Syndrome

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Co-author 1

Weihua Zheng zhengweihua@shchildren.com.cn Shanghai Children’s Hospital, Shanghai Jiao Tong University School of medicine Department of Nephrology and Rheumatology Shanghai China *

Co-author 2

Jianxin Sun sunjianx2000@163.com Women's and Children's Hospital of Ningbo Universit Department of Paediatrician Ningbo China -

Co-author 3

Ying Wu wuy@shchildren.com.cn Shanghai Children’s Hospital, Shanghai Jiao Tong University School of medicine Department of Nephrology and Rheumatology Shanghai China -

Co-author 4

Guang-hua Zhu zhugh@shchildren.com.cn Shanghai Children’s Hospital, Shanghai Jiao Tong University School of medicine Department of Nephrology and Rheumatology Shanghai China -

Co-author 5

Wen-yan Huang huangwy@shchildren.com.cn Shanghai Children’s Hospital, Shanghai Jiao Tong University School of medicine Department of Nephrology and Rheumatology Shanghai China -

Co-author 6

Yulin Kang kangyl@shchildren.com.cn Shanghai Children’s Hospital, Shanghai Jiao Tong University School of medicine Department of Nephrology and Rheumatology Shanghai China -

Co-author 7

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Introduction

Previous research has suggested that disruptions in intestinal flora and increased gastrointestinal mucosal permeability may contribute to the onset and recurrence of primary nephrotic syndrome (PNS) in children. Glutamine can repair damaged intestinal mucosa and may have potential benefits for children with PNS. This study aims to assess the efficacy and safety of glutamine in combination with prednisone acetate for treating children with PNS.

Methods

Recruitment flowchart for children diagnosed with newly-diagnosed PNS.

We retrospectively analyzed clinical data from 100 children diagnosed with PNS between June 2018 and June 2022. Outpatient follow-up was extended until June 2024. These children were categorized into two groups: those receiving glutamine supplementation and a control group. We compared the duration to achieve complete remission following initial prednisone therapy, the frequency of PNS recurrence, and the number of infections during the follow-up period. Additionally, adverse events and clinical pathophysiological characteristics were documented and analyzed alongside factors influencing PNS recurrence.

Results

Comparison of Outcome Indicators Between Two Groups of Children with PNS

The glutamine group experienced a significantly shorter duration to complete remission compared to the control group (P<0.05). Moreover, the glutamine group had a lower rate of PNS recurrence (46% vs. 62%) and fewer infections during follow-up (P<0.05). No significant toxic or side effects were observed among children receiving glutamine. Multivariate Cox regression analysis identified family history and the number of infections as independent predictors of PNS recurrence in children (P<0.05).

Conclusion

The combination of glutamine and prednisone acetate not only reduces the time to achieve complete remission after initial therapy in children with PNS but also decreases the frequency of PNS recurrences and infections.

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