| Objective:By analyzing the clinical characteristics,clinical medication and laboratory examinations of patients with primary nephrotic syndrome(PNS)in a nephrology department of a tertiary hospital,to explore the correlation between different medication regimens of patients and pre-treatment laboratory indicators and to explore whether they are helpful to determine the response of patients to hormones,and to analyze the related factors of complications such as infection,acute kidney injury and thrombosis in PNS patients.In addition,by carrying out pharmaceutical care on patients to ensure the patients’ medication can be safe,reasonable and effective.Methods:From January 2015 to October 2021,529 patients with PNS who were admitted to the nephrology department of a tertiary hospital were selected as the research objects,and the clinical data of all patients were collected,including general information,laboratory tests and drug used.The patients are divided into groups according to their medication status,response to hormones,and the presence or absence of complications.By comparing clinical data between different groups,analyze the role of laboratory indicators in formulating individualized drug regimens,judging patients’ response to hormones,and predicting complications.SPSS 26.0software was used for data analysis;ROC diagram was drawn using Graphpad Prism9.3.Result:1.Demographic characteristics and distribution of pathological types: A total of 529 PNS patients were included in this study,including 319 males(60.30%)and 210females(39.70%);a total of 234(44.23%)patients received renal biopsy,137(58.55%)patients were diagnosed with membranous nephropathy,49(20.94%)patients were diagnosed minimal change nephropathy,and 45(19.23%)were diagnosed Ig A nephropathy;the main pathological type of juvenile PNS patients was minimal change nephropathy;the main pathological type of middle-aged and elderly patients were membranous nephropathy.2.The analysis results of each index in the basic treatment group and the immunosuppressive treatment group of patients with different pathological types showed that: in patients with membranous nephropathy,compared with the basic treatment group,the immunosuppressive treatment group had lower total protein,serum albumin,prealbumin,immunoglobulin G,fasting blood glucose,while blood urea nitrogen,serum cystatin C,fibrinogen quantification were higher,and the difference of the above indicators between the two groups was statistically significant(p<0.05);in patients with minimal change nephropathy,compared with the basic treatment group,the α1 globulin in the immunosuppressive treatment group was lower,and the difference between the two groups was statistically significant(p<0.05);in patients with Ig A nephropathy,compared with the basic treatment group,the immunosuppressive treatment group had higher proportion of males,red blood cells,hemoglobin,aspartate aminotransferase,alanine aminotransferase,total cholesterol,and high-density lipoprotein cholesterol,while the combined hypertension rate,immunoglobulin G,calcium were lower,and the differences of the above indicators between the two groups were statistically significant(p<0.05).There were no significant differences in other indicators between patients(p>0.05).3.The analysis results of hormone-sensitive group and hormone-resistant group showed: There were significant differences in the response to hormones in patients of different age groups(p<0.05).Compared with the two groups of patients,the patients in the hormone-resistant group had the combined hypertension rate,BMI,white blood cells,γ-glutamyl transpeptidase,serum creatinine,blood urea nitrogen,serum cystatin C,triglyceride,erythrocyte sedimentation rate and lactate dehydrogenase were higher,but the Ig A value was lower,the above differences were statistically significant(p<0.05),and the other indicators were not significantly different between the two groups of patients(p> 0.05).Multivariate logistic regression analysis showed that white blood cells were an independent risk factor for steroid resistance in PNS patients,and the area under the ROC curve for predicting steroid resistance was 0.665(95%CI:0.584-0.745),and the optimal critical value was 7.775 ×109.4.Compared with the patients without infection,the infection group had more females,higher rates of acute kidney injury,higher blood platelet,total cholesterol,alkaline phosphatase,blood urea nitrogen,phosphorus,erythrocyte sedimentation rate,α-hydroxybutyrate dehydrogenase and lactate dehydrogenase values,while the values of BMI,serum albumin,prealbumin,sodium,and chlorine were lower.The above differences were statistically significant(p<0.05),and there was no significant difference among the other indicators(p>0.05).Multivariate logistic regression analysis showed that gender was an independent risk factor for infection in PNS patients,and women were more likely to develop infection than men.The area under the ROC curve for predicting infection in patients by gender was 0.570(95%CI:0.516-0.624).5.Compared with patients without acute kidney injury,the acute kidney injury group had higher age,infection rate,BMI,Beta,Triglyceride,blood urea nitrogen,serum creatinine,cystatin C,uric acid,C4,prothrombin time,prothrombin time ratio,fibrinogen quantification,thrombin time,d-dimer,erythrocyte sedimentation rate,α-hydroxybutyrate dehydrogenase and lactate dehydrogenase values,while red blood cell,total protein,serum albumin,A/G,calcium values were lower.The above differences were all statistically significance(p<0.05),and there was no significant difference between other indicators(p>0.05).Multivariate logistic regression analysis showed that BMI,serum creatinine and erythrocyte sedimentation rate were independent risk factors for acute kidney injury.The area under the ROC curve of the combined factor for predicting acute kidney injury was 0.744(95%CI: 0.675-0.813).Conclusion:1.In patients with membranous nephropathy,compared with the basic treatment group,the immunosuppressive treatment group had lower total protein,serum albumin,prealbumin,immunoglobulin G,fasting blood glucose,while blood urea nitrogen,serum cystatin C,fibrinogen quantification were higher,the above indicators may have certain reference significance in whether patients with membranous nephropathy use immunosuppressive therapy;in patients with minimal change nephropathy,compared with the basic treatment group,the α1 globulin in the immunosuppressive treatment group was lower,α1 globulin may have certain reference significance in whether patients with minimal change nephropathy use immunosuppressive therapy;in patients with Ig A nephropathy,compared with the basic treatment group,the immunosuppressive treatment group had higher proportion of males,red blood cells,hemoglobin,aspartate aminotransferase,alanine aminotransferase,total cholesterol,and high-density lipoprotein cholesterol,while the combined hypertension rate,immunoglobulin G,calcium were lower,the above indicators may have certain reference significance in whether patients with Ig A nephropathy use immunosuppressive therapy.2.Compared with the hormone-sensitive group,the patients in the hormone-resistant group had the combined hypertension rate,BMI,white blood cells,γ-glutamyl transpeptidase,serum creatinine,blood urea nitrogen,serum cystatin C,triglyceride,erythrocyte sedimentation rate and lactate dehydrogenase were higher,but the Ig A value was lower.The above indicators may be useful for judging the response of PNS patients to hormones,and the white blood cell value was an independent risk factor for hormone resistance in PNS patients.3.The concurrent infection in PNS patients is related to many factors,among which gender was an independent risk factor for infection in PNS patients.Compared with males,females were more prone to infection.4.The concurrent acute kidney injury in patients with PNS is related to many factors,among which BMI,serum creatinine and erythrocyte sedimentation rate were independent risk factors for acute kidney injury. |
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