对1例原发性肾病综合征患者的药学监护

1例34a男性患者,因原发性肾病综合征、轻度系膜增生性肾小球肾炎采用足量激素治疗8周后临床未完全缓解,为行进一步诊治入院。入院查肝功能异常,肾穿刺病理切片重新阅片后诊断更正为膜性肾病（Ⅱ期）,给予糖皮质激素联合环孢素A治疗,同时给予保肝、抗凝、调脂、降低尿蛋白等对症治疗。针对患者肝功能异常、需长期应用糖皮质激素和环孢素A等特点,药学监护集中于监测他汀类调脂药的肝损害、应用环孢素A时调脂药的选择、糖皮质激素性骨质疏松的预防,同时通过用药教育提高病人用药依从性,减少潜在的用药风险。患者出院后继续规律应用糖皮质激素和环孢素A并缓慢减量,随访8个月,患者尿蛋白完全缓解（24h尿蛋白定量〈300mg）,肝功能、血脂均正常。

Pharmaceutical care on a patient with primary nephrotic syndrome

A 34-year-old male patient with primary nephrotic syndrome,mild mesangial proliferative glomerulonephritis using full dosage hormonal therapy for 8 weeks and being not complete remission was hospitalized for further diagnosis and treatment.Clinical diagnosis was corrected as membranous nephropathy（Ⅱphase） by re-examining pathological section and the patient was treated with combination of cyclosporin A and glucocorticoid accordingly as well as symptomatic treatment such as protecting liver function,anticoagulation,adjusting blood fat,decreasing urine protein.Basing on liver disfunction and longterm medication of glucocorticoid and cyclosporin A,pharmaceutical care focused on monitoring liver function induced by statins,choosing drugs for decreasing cholesterol while using cyclosporin A,preventing osteoporosis induced by glucocorticoid and increasing patient＇s compliance,decreasing potential medication risk by medication education.The patient continued to use glucocorticoid and cyclosporin A regularly and decreased dosages slowly.Follow-up for 8 months showed urine protein reached complete remission（24 hours urine protein quantitation was less than 300 mg）,levels of aminotransferase and cholesterol were normal.