Herbal Medicine "Shulifenxiao" Formula for Nephrotic Syndrome of Refractory Idiopathic Membranous Nephropathy

Background: Treatment for adult patients with refractory idiopathic membranous nephropathy (RIMN) by conventional immunosuppressive regimens is not satisfactory. This study aims to evaluate the effectiveness of Chinese herbal medicine, Shulifenxiao formula, as a promising regimen. Methods: A total of 31 RIMN patients resistant to corticosteroid or immunosuppressive agents were retrospectively analyzed. Shulifenxiao treatment lasted a minimum of 12 degrees months in all patients and extended to 24 degrees months in 11 patients. The primary outcomes [the complete remission (CR) and partial remission (PR)] and secondary outcomes (the serum creatinine and estimated glomerular filtration rate (eGFR) levels) were measured at 6, 12, 18, and 24 degrees months. Results: The data provided an average follow-up of 21 +/- 9.16 degrees months from baseline. The remission was attained in 25/31 patients (80.7%: CR 29.0% and PR 51.6%) at 12 degrees months and in 10/11 patients (90.9%: CR 54.6% and PR 36.4%) at 24 degrees months, respectively. Proteinuria reduced from 6.02 g/d at baseline to 0.98 g/d at 12 degrees months (p < 0.001) and to 0.27 g/d at 24 degrees months (p = 0.003); serum albumin increased from 28 g/L to 37.2 g/L at 12 degrees months (p < 0.001) and to 41.3 g/L at 24 degrees months (p = 0.003); eGFR improved from 100.25 ml/min/1.73 m(2) to 118.39 ml/min/1.73 m(2) at 6 degrees months (p < 0.001) and finally to 111.62 ml/min/1.73 m(2)at 24 degrees months (p = 0.008). Only two patients developed subsequent relapse. Conclusion: Shulifenxiao formula as a clinical cocktail therapy serves as an alternative therapeutic option for steroid and immunosuppressant-resistant RIMN patients, with a favourable safety profile, though further studies are warranted.