{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,4,13]],"date-time":"2026-04-13T14:40:45Z","timestamp":1776091245967,"version":"3.50.1"},"reference-count":26,"publisher":"Frontiers Media SA","license":[{"start":{"date-parts":[[2021,5,10]],"date-time":"2021-05-10T00:00:00Z","timestamp":1620604800000},"content-version":"vor","delay-in-days":0,"URL":"https:\/\/creativecommons.org\/licenses\/by\/4.0\/"}],"funder":[{"DOI":"10.13039\/501100014857","name":"National Natural Science Foundation of China-Guangdong Joint Fund","doi-asserted-by":"publisher","award":["81570656 81774278"],"award-info":[{"award-number":["81570656 81774278"]}],"id":[{"id":"10.13039\/501100014857","id-type":"DOI","asserted-by":"publisher"}]}],"content-domain":{"domain":["frontiersin.org"],"crossmark-restriction":true},"short-container-title":["Front. Pharmacol."],"abstract":"<jats:p><jats:bold>Background:<\/jats:bold> 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.<\/jats:p><jats:p><jats:bold>Methods:<\/jats:bold> A total of 31 RIMN patients resistant to corticosteroid or immunosuppressive agents were retrospectively analyzed. Shulifenxiao treatment lasted a minimum of 12\u00b0months in all patients and extended to 24\u00b0months 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\u00b0months.<\/jats:p><jats:p><jats:bold>Results:<\/jats:bold> The data provided an average follow-up of 21 \u00b1 9.16\u00b0months from baseline. The remission was attained in 25\/31 patients (80.7%: CR 29.0% and PR 51.6%) at 12\u00b0months and in 10\/11 patients (90.9%: CR 54.6% and PR 36.4%) at 24\u00b0months, respectively. Proteinuria reduced from 6.02\u00a0g\/d at baseline to 0.98\u00a0g\/d at 12\u00b0months (<jats:italic>p<\/jats:italic> &amp;lt; 0.001) and to 0.27\u00a0g\/d at 24\u00b0months (<jats:italic>p<\/jats:italic> = 0.003); serum albumin increased from 28\u00a0g\/L to 37.2\u00a0g\/L at 12\u00b0months (<jats:italic>p<\/jats:italic> &amp;lt; 0.001) and to 41.3\u00a0g\/L at 24\u00b0months (<jats:italic>p<\/jats:italic> = 0.003); eGFR improved from 100.25\u00a0ml\/min\/1.73\u00a0m<jats:sup>2<\/jats:sup> to 118.39\u00a0ml\/min\/1.73\u00a0m<jats:sup>2<\/jats:sup> at 6\u00b0months (<jats:italic>p<\/jats:italic> &amp;lt; 0.001) and finally to 111.62\u00a0ml\/min\/1.73\u00a0m<jats:sup>2<\/jats:sup>at 24\u00b0months (<jats:italic>p<\/jats:italic> = 0.008). Only two patients developed subsequent relapse.<\/jats:p><jats:p><jats:bold>Conclusion:<\/jats:bold> 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.<\/jats:p><jats:p><jats:bold>Clinical Trial registration:<\/jats:bold><jats:ext-link>http:\/\/www.chictr.org.cn<\/jats:ext-link>, Chinese Clinical Trials Registry [ChiCTR1800019351].<\/jats:p>","DOI":"10.3389\/fphar.2021.675406","type":"journal-article","created":{"date-parts":[[2021,5,10]],"date-time":"2021-05-10T07:39:20Z","timestamp":1620632360000},"update-policy":"https:\/\/doi.org\/10.3389\/crossmark-policy","source":"Crossref","is-referenced-by-count":11,"title":["Herbal Medicine \u201cShulifenxiao\u201d Formula for Nephrotic Syndrome of Refractory Idiopathic Membranous Nephropathy"],"prefix":"10.3389","volume":"12","author":[{"given":"Hailan","family":"Cui","sequence":"first","affiliation":[],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Frank Qiang","family":"Fu","sequence":"additional","affiliation":[],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Baoli","family":"Liu","sequence":"additional","affiliation":[],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Wei Jing","family":"Liu","sequence":"additional","affiliation":[],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Yu Ning","family":"Liu","sequence":"additional","affiliation":[],"role":[{"role":"author","vocabulary":"crossref"}]}],"member":"1965","published-online":{"date-parts":[[2021,5,10]]},"reference":[{"key":"B1","doi-asserted-by":"publisher","first-page":"81","DOI":"10.1097\/maj.0b013e31824ce676","article-title":"Outcomes of Tacrolimus Therapy in Adults with Refractory Membranous Nephrotic Syndrome: a Prospective, Multicenter Clinical Trial","volume":"345","author":"Chen","year":"2013","journal-title":"Am. 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