A Study Of The Relationship Between The Treatment Of Methyl Prednisolone Pulse Therapy And Eye Damage In Children With Nephritic Syndrome

Objective:Children with nephrotic syndrome are treated with the methyl prednisolone pulse therapy as a sequential therapy. It has been confirmed that this treatment really works well. Most of the diseases are under control so this treatment is good news to children with persistent nephrotic syndrome. It is well known that the first choice for children with nephrotic syndrome is hormone therapy, which, however, will inevitably produce many side-effects. The impact of the hormone therapy on eyes has caught the attention of clinical doctors and preventive measures have been made. Now the adverse ocular reactions of this treatment have not been reported at home and abroad yet. This study aims to elaborate whether the methyl prednisolone pulse therapy will cause eye damages as the conventional oral hormone therapy did or it will cause even severe lesions. Therefore, the conclusions made in this study can guide the dosage and the time for the use of glucocorticoids in children with nephrotic syndrome. Thus we can reduce the side effects as much as possible in the treatment of nephritic syndrome, so as to improve the life quality of such children patients.Methods:40 children who have been diagnosed with nephritic syndrome are selected from the Second Hospital of Hebei Medical University from January 2013 to January 2015. Among them 29 cases are boys and 11 cases are girls, ranging in age from 3 to 14. These 40 patients are divided into the methyl prednisolone pulse therapy group and the general treatment group. 20 cases belong to the methyl prednisolone pulse therapy groups, namely the experimental group, and the remaining 20 cases are of oral hormone therapy group, namely the general treatment group. A comparison is made between those patients and 20 cases of healthy children who made health consultationsin our hospital and agreed to accept eye examination.Among the 20 cases,10 are boys and 10 are girls,aging from 3 to 14.Before the oral hormone therapy,the eye pressure and eye fundus of those 40 patients were examined in our hospital.The result indicates that their eye pressure is normal,and they have no cataract or glaucoma.Among the 40 patients,27 cases(which accounts 67.5 percent)are of simple nephrotic syndrome and 13cases(which accounts 32.5percent)are of nephritis nephropathy.Patients are people with refractory nephritic syndrome,among which 15 case are recurrent types,2 cases are with steroid-dependent and 3 cases are with steroid-resistant nephrotic syndrome.We operate kidney biopsy on 11 patients to identify their pathologic types.Among them,5 cases are with minimal change nephrosis,3 cases are with membranous nephropathy,2 cases are with mesangial proliferative and 1 cases are with focal segmental glomerular sclerosis.The methyl prednisolone pulse therapy is treated as the time segment.Before it we collect the data of those sick children’s blood pressure(systolic pressure)and intraocular pressure,the slit lamp,ophthalmoscope and the results of the perimeter examination(including anterior segement,C/D,lens lesions,and field of vision).15-30mg/Kg(maximum dose 1000mg)methylprednisolone sodium succinate is added in 150-200ml of 5%glucose injection in the experimental group.Then an intravenous infusion of 1-2 hours is given.Some patients may not bear the impact therapy,so some special circumstances occur for example a rise in blood pressure.With the permission of clinical conditions,the treatment can be changed to once every other day after a symptomatic treatment.The total course lasts for three days.During the treatment of the methyl prednisolone pulse therapy the use of oral glucocorticoids need to be stopped.Then continue to adopt the oral glucocorticoids treatment and other related oral medicine treatment when the methyl prednisolone pulse therapy is finished.And then collect the data of all patients’blood pressure,intraocular pressure,the slit lamp and the results of the fundus examination.Wherein,the data of the blood pressure is collected by the same person with the same blood pressure gauge under the same circumstance.The data of the intraocular pressure,the slit lamp and the results of the fundus examination are measured by ophthalmic surgeons of our hospital,who have the same academic title,with the same type gauge.Statistical processing methods:we use the variance analysis of the SPSS17.0 statistical software.It has two factors and can measure the data repeatedly.It is used to compare the blood pressure,the intraocular pressure and the fundus lesions of the experimental group before and after the methyl prednisolone pulse therapy.Meanwhile,a comparison of the blood pressure,the intraocular pressure and the fundus lesions before and after the methyl prednisolone pulse therapy is made between the experimental group and the general treatment group.The same comparison is also conducted with the healthy children.Linear correlation is used to analysis the relationship between the blood pressure and the intraocular pressure.By chi-square test on the comparison to the experimental group and the general treatment group in the incidence of cataract.Results :1 In the experimental group, the pressure of the left eye and right eye during the methyl prednisolone pulse therapy has a obvious statistical significance compared with that before the therapy(P<0.05). During the methyl prednisolone pulse therapy, the pressure of the left eye is(17.080 ±0.562) and the right eye is(16.920±0.487). They increased significantly because the pressure of the left eye and right eye are respectively(15.927 ±0.584) and(15.447±0.567) before the therapy. After one week, one month,six months,a year of the therapy, they have no statistical significance(P>0.05). There also exist statistical significances in the change of intraocular pressure after two years of the therapy. In the general treatment group, the change of intraocular pressure also has statistical significances after two years of the treatment(P=0.012). The intraocular pressure of healthy children within the observation period has no statistical significance(P>0.05).2 In the experimental group, the blood pressure(systolic pressure) during the methyl prednisolone pulse therapy has a obvious statistical significance compared with it before the therapy(P=0.03). During the methyl prednisolone pulse therapy, the blood pressure is(130.87±2.70). Compared with the blood pressure(109.47±3.35) before the therapy, it rises obviously. After one week, one month,half a year, a year or two years of the therapy, the blood pressure has no statistical significance compared with that before the therapy(P>0.05). In the general treatment group and the control group, the blood pressure has no apparent changes in each time interval(P>0.05).3 In the experimental group, both the changes of intraocular pressure and blood pressure during the methyl prednisolone pulse therapy have statistical significance compared with those before the therapy. What’s more, the trends of their linear graphs have certain resemblance. The rise of intraocular pressure and blood pressure is resulted from the methyl prednisolone pulse therapy. So it is speculated that there exists correlation between the rise of intraocular pressure and blood pressure. However the relative results can not be brought forth through linear correlation analysis(Pearson Correlation=0.258,P=0.354), they have no statistical significance.4 In the two years’ observation, the intraocular pressure of the patients is on the rise overall, although it doesn’t reach the diagnostic criteria of the high intraocular pressure. With three patients, the general treatment group have two patients suffer from cataracts in accordance with the fundus observation. the methyl prednisolone pulse therapy group and the general treatment group in the incidence of cataract by chi-square test showed statistically insignificant(χ2=0.223,P>0.05).The anterior segement, C/D, lens lesions, and field of vision of all children during the observation undergo no obvious changes.Conclusions:1 The short-term effects of the methyl prednisolone pulse therapy can elevate intraocular pressure in children with nephrotic syndrome.2 The short-term effects of the methyl prednisolone pulse therapy can elevate blood pressure in children with nephrotic syndrome.3 Both the intraocular pressure and blood pressure of children with nephritic syndrome during the methyl prednisolone pulse therapy rise compared with those before the treatment, however they have no linear correlation.4 There exists no direct relation between the glucocorticoid-induced contracts children with nephritic syndrome and the methyl prednisolone pulse.