| Objective:To explore the comparison between senile nephrotic syndrome and non-senile nephrotic syndrome in clinical features,pathological type distribution and curative effect under different treatment methods,so as to understand the characteristics of senile nephrotic syndrome more clearly and guide diagnosis and treatment.Method:1 Participants: a total of 277 patients with nephrotic syndrome hospitalized in the Department of Nephrology of our hospital from January2019 to March 2020 were divided into two groups: elderly group(≥ 60 years old)and non-elderly group(<60 years old).Elderly group(n=110),Non-elderly group(n = 167).2 Record the general information of the candidates(sex,age,medical history and past history,etc.).3 Laboratory examination and pathological classification: all subjects were examined by blood pressure monitoring,blood routine,urine routine,stool routine,liver and kidney function,24-hour urinary protein,blood lipids,secondary factor screening and other laboratory tests.For the patients who underwent renal biopsy,the pathological classification was based on WHO(1995)revised plan for histological classification of glomerular disease and the guidance for pathological diagnosis of renal biopsy in China.4 Treatment and follow-up: two groups of patients with MN and MCD were followed up for 6 months and 12 months.Among them,all patients were given low-salt,low-fat and high-quality protein diet,diuretic detumescence,blood pressure,urine protein,lipid regulation,anticoagulation and other routine targeted treatment.Hormone and / or immunosuppressants are used under the condition of excluding contraindications of hormones and/ or immunosuppressants and informing patients and their families of their illness and signing informed consent;immunosuppressants include cyclophosphamide and cyclosporine A,and actively prevent and cure the complications in the treatment.5 Efficacy judgment:(1)Complete remission: 24-hour urinary protein quantity < 0.3g or urinary protein / creatinine(u PCR)< 300 mg / kg,normal renal function,plasma albumin > 35 g / kg,urinary protein negative;(2)Partial remission: 24-hour urinary protein quantity > 0.3g,but < 3.5g;or u PCR at 300 mg / 3500 mg / g;or 24-hour urinary protein decreased by 50%compared with the baseline level and renal function was stable.(3)No remission: the quantity of 24-hour urinary protein was more than 3.5g,and the decrease was less than 50% of the baseline level.Effective = complete remission + partial remission.6 Statistical methods: SPSS22.0 statistical software was used for processing and analysis.The measurement data of normal distribution were expressed as mean ±standard deviation,and t-test was used for comparison between groups.The measurement data of non-normal distribution are represented by median and quartile intervals,and rank sum test is used for inter-group comparison.The counting data were expressed by frequency and percentage,and chi-square test was used for comparison between groups.The difference was statistically significant(P < 0.05).Results:1 The general situation of the object of studyA total of 277 subjects were included in this study: elderly group(n =110),male(n = 78)and female(n = 32),and non-elderly group(n = 167),male(n = 114)and female(n = 53).2 Comparison of basic clinical features between the two groupsThe proportion of hypertension,renal function damage and anemia in the elderly group at the first visit was significantly higher than that in the non-elderly group(p=0.000,p=0.000,p=0.027,respectively).The values of blood urea nitrogen and serum creatinine in the elderly group were significantly higher than those in the non-elderly group(p=0.000,p=0.001,respectively),and the proportion of diabetes,coronary heart disease and cerebrovascular disease in the elderly group was significantly higher than that in the non-elderly group(p=0.017,p=0.000,p=0.000,respectively).3 Comparison of pathological types and secondary etiology between the two groupsThere was no significant difference in the ratio of primary NS to secondary NS between the two groups(p= 0.093).There was no significant difference in the distribution of pathological types between the two groups(p > 0.05).The proportion of lupus nephritis in the elderly group was significantly lower than that in the non-elderly group(p= 0.048).4 Evaluation of Therapeutic effects of different Therapeutic schemes for MN of NS patients in the elderly GroupIn elderly patients with membranous nephropathy,the 6-month effective rate of hormone combined with cyclophosphamide was significantly higher than that of hormone combined with cyclosporine(p=0.041).In elderly patients with membranous nephropathy,the 12-month effective rate of hormone combined with cyclophosphamide was also significantly higher than that of hormone combined with cyclosporine(p= 0.023).5 Evaluation of Therapeutic effects of different Therapeutic schemes for MN of NS patients in the non-elderly GroupIn non-elderly patients with membranous nephropathy,the 6-month effective rate of hormone combined with cyclophosphamide was significantly higher than that of hormone combined with cyclosporine(p=0.049).In non-elderly patients with membranous nephropathy,the12-month effective rate of hormone combined with cyclophosphamide was also significantly higher than that of hormone combined with cyclosporine(p= 0.012).6 Comparison of Therapeutic effects between elderly and non-elderly patients with membranous Nephropathy under different treatment regimensThere was no significant difference in the 6-month and 12-month effective rate between the elderly group and the non-elderly group in the treatment of membranous nephropathy with hormone combined with cyclophosphamide at 6 months and 12 months(p=0.792,p=0.901).Similarly,there was no significant difference in the effective rate of membranous nephropathy between the elderly group and the non-elderly group at 6months and 12 months after administration of hormone combined with cyclosporine(p=0.593,p=0.801).There was no significant difference in the12-month effective rate between the two groups of patients with membranous nephropathy who were only treated with symptomatic support(p= 0.907).7 Comparison of the efficacy of hormone therapy between the elderly group with MN and the non-elderly group with MNThere was no significant difference in the 6-month and 12-month effective rate between the elderly patients with MN and the non-elderly patients with MN treated with corticosteroids at 6 months and 12 months(p=0.223,p=0.876).Conclusion:In summary,as shown by the comparison between elderly NS and non-elderly NS,both are predominantly membranous nephropathy;elderly NS have more severe clinical manifestations,more comorbidities,and complex pathological types and etiologies,which require comprehensive and careful consideration in diagnosis and treatment;moreover,the use of hormones and immunosuppression needs to be combined with pathological types,so we should clarify the pathological diagnosis to guide treatment according to the situation as early as possible kidney biopsy;for membranous nephropathy and microscopic lesions that manifest as nephropathy syndrome of membranous nephropathy and microscopic lesions,with rational application and strict monitoring and management of complications,the elderly can achieve a more desirable treatment outcome similar to that of the non-elderly. |
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