Expression Of GRα, GRβ On PBMC And Kidney Tissues Of Patients With Primary Nephrotic Syndrome

Objective To investigate the expression of GRα,GRβon PBMC and kidney tissues of patients with Primary Nephrotic Syndrome and the role of them on the steroid resistance and the possible mechanism involved.Method 25 children with PNS without any glucocorticoid treatment before admission were divided into two groups: 10 children with steriod-resistant nephrotic syndrome (SRNS) ,and 15 with steriod-sensitive nephrotic syndrome (SSNS),according to their response to glucocorticoid;10 healthy check-up children as normal control group (control). Reverse transcription-polymerase chain reaction (RT-PCR) were applied to detect the expression of GRαmRNA and GRβmRNA on PBMC at different time (A,before prednisone treatment; B,after 4 weeks'prednisone treatment); Renal biopsy was adopted to get samples from children with SRNS after 4 weeks'prednisone treatment,immunohistochemistry was used to detect the expression level of GRαand GRβ,choose 5 cases normal children kidney tissues in comparison.Results (1)There are both GR alpha and grbeta expression on PBMC in SSNS,SRNS and Control ,especially GR alpha;(2)Peripheral GRαmRNA expression in PBMC: There are no significant differences between control,SRNS and SSNS before treatment(A),but after 4 weeks'prednisone therapy(B), the expressions are all declined in SSNS and SRNS groups (p < 0.05).(3)The expression of GRβmRNA in SRNS are higher than SSNS and Control at A(p<0.05); GRβmRNA at B are higher than A(p<0.05).(4)Renal tissues grbeta expression are higher than normal control group, but GR alpha expression are lower than the normal control group (both P < 0.05),(5)A positive linear correlation between the expression of GR beta on PBMC and 24hUTA,pathological integral were found,(r=0.469,0.672 respectively,both p<0.05).The renal tissues grbeta gray value in SRNS are negatively related to pathological integral (r = -0.7826, p < 0.05), Namely, the lower of the kidney tissues gray value the higher of the grbeta expression. The higher of the Pathological integral ,the heavier of the renal involvement degreet.24-hour urinary protein quantitative in SRNS and pathological integral have postive relevance (r = 0.648, p < 0.05), peripheral grbeta mRNA expressions in PBMC have negative correlations with renal tissues grbeta gray value (r =-0.6502, p < 0.05),Namely the expression of GR beta in PBMC have significantly positive correlations with the grbeta expression in kidney.Conclusion (1)After GC treatment,the GR alpha declines could be one of the reasons in the decrease of the steriod sensitivity in PNS(;2)Abnormal elevated GR beta on PBMC in SRNS explain that there are steriod-resistant factors before GC treatment,after the treatment , inceased GR beta can further induce steriod-resistance;(3)GR beta in PBMC have relations with 24h urine protein quantitative,GR beta in kidney and Pathological integral;illustrate that GR beta can reflect the severity of the disease.