To investigate the intervention efficacy and underlying mechanism of Modified Danggui Shaoyao Powder on steroid-related adverse reactions in children with nephrotic syndrome.

A total of 64 children with newly diagnosed nephrotic syndrome admitted to the Pediatric Ward of Heilongjiang Provincial Hospital of Traditional Chinese Medicine from October 2024 to December 2025 were enrolled and randomly divided into an observation group and a control group using a random number table, with 32 cases in each group. Both groups received routine basic treatment for nephrotic syndrome plus standardized glucocorticoid therapy. In addition, the control group received Huaiqihuang Granules, while the observation group received Modified Danggui Shaoyao Powder. The treatment course lasted 8 weeks. The following parameters were observed and compared between the two groups at three time points: T1 (at the time of achieving dry weight), T2 (14 days after achieving dry weight), and T3 (after 8 weeks of full-dose steroid therapy): Yin deficiency and internal heat syndrome scores, body fat-related indicators (BMI and waist-to-height ratio [WHtR]), HPA axis function indicators (cortisol [COR], adrenocorticotropic hormone [ACTH], 24-hour urinary free cortisol [24 hUFC], and low-dose dexamethasone suppression test [LDST]), and bone metabolism markers (25-hydroxyvitamin D[25(OH)D] and procollagen type I N-terminal propeptide [P1NP]).

At T1, there were no significant differences between the two groups in syndrome scores, BMI, WHtR, HPA axis indicators, or bone metabolism markers (P>0.05). At T2 and T3, the observation group showed significantly lower Yin deficiency and internal heat syndrome scores than the control group (P<0.01). At T3, the observation group had significantly lower BMI and WHtR (P<0.01), and significantly higher levels of COR, 24 hUFC, LDST, 25 (OH) D, and P1NP compared with the control group (P<0.05, P<0.01).

Modified Danggui Shaoyao Powder can effectively alleviate the Yin deficiency and internal heat syndrome manifestations induced by glucocorticoid therapy in children with nephrotic syndrome, and attenuate steroid-induced abnormalities in body fat metabolism, HPA axis suppression, and bone metabolism disorders, thereby exerting a counteractive effect against steroid-related adverse reactions.