Factor Analysis Of The Hormonal Differences In The Efficacy Of Primary Nephrotic Syndrome

Purpose:According to adults and children’s primary nephrotic syndrome cases material analysis, this paper discusses the differences caused by hormonal factors (such as pathological types, tubulointerstitial urine protein, hematuria, immune factors, biochemical index, etc.), and to provide the basis for the treatment and prognosis of clinical primary nephrotic syndrome.Methods:Collect the clinical data and renal histological findings of the Second Xiang ya Hospital Kidney internal medicine and pediatrics from2001to2012,513cases of primary nephrotic syndrome,430cases of adults, children83cases; retrospectively analysis all cases data and pathological findings.The patient’s gender, age, pathological type, tubulointerstitial lesions, urine protein, hematuria, C3, C4,, BUN, and Cr, TG and CH, the TP, ALB, RBP and other.The effect to the corticosteroid treatment differences was compared.Results1Hormone therapy:430cases of adult PNS patients after regular treatment of hormone sensitive hormone, found in266cases, accounting for61.86%; hormone resistance in164cases, accounting for38.14%. In83cases of children with PNS hormone sensitivity in55cases, accounting for66.27%; resistance in28cases, accounting for33.73%. Adult and children in hormone effects on distribution, the chi-square value is0, P>0.05.2Age, gender and hormonal differences in efficacy analysis: Adults,35years of age for the sector, were divided into two groups, less than or equal to35years of age for the younger group, more than35years of age in the older group. Young group and elderly group were than with corticosteroid treatment in chi-square test, P<0.05, significant difference. Adults and children of men and women were than with corticosteroid treatment differences in chi-square test, P>0.05, no significant meaning.3Histologic types of distribution and hormonal differences in efficacy of correlation analysis:430cases of adult patients with PNS and pathological types of hormone sensitive/resistance relationships are: minor glomerular lesions (MCD) in164cases, the total number of cases of38.13%, hormone sensitive in127cases, accounting for77.44%, in the adult hormone sensitive group accounted for47.39%; hormone resistance in37cases, accounting for22.56%, on adult hormone resistance groups accounted for22.84%. Mesangial proliferative glomerulonephritis (MsPGN) in113cases, the total number of cases of26.29%, hormone sensitive in85cases, accounting for75.22%, in the adult hormone sensitive group accounted for31.72%; hormone resistance in28cases, accounting for24.78%, on adult hormone resistance groups accounted for 17.28%.; membranous nephropathy (MN) in54cases, the total number of cases of12.56%, hormone sensitive in18cases, accounting for33.33%, in the adult hormone sensitive group accounted for6.72%; hormone resistance in36cases, accounting for66.67%, on adult hormone resistance groups accounted for22.22%. Focal segmental glomerulosclerosis (FSGS) in48cases, the total number of cases of11.1%, hormone sensitive in16cases, accounting for33.33%, in the adult hormone sensitive group accounted for5.97%; hormone resistance in32cases, accounting for66.67%, on adult hormone resistance groups accounted for19.75%. IgA nephropathy (IgAN) in35cases, the total number of cases of8.14%, hormone sensitive in19cases, accounting for54.28%, in the adult hormone sensitive group accounted for7.09%; hormone resistance in16cases, accounting for45.71%, on adult hormone resistance groups accounted for9.88%. Sclerosing glomerulonephritis (SGN) in10cases, the total number of cases of2.33%, hormone sensitive in2cases, accounting for20%, in the adult sensitive group accounted for0.75%; resistance in8cases, accounting for80%, on adult hormone resistance groups accounted for4.94%. Capillary in proliferative glomerulonephritis (EnPGN) in6cases, the total number of cases of1.4%, hormone sensitive in1cases, accounting for16.67%, in the adult hormone sensitive group accounted for0.37%; hormone resistance in5cases, accounting for83.33%, on adult hormone resistance groups accounted for3.09%. In83cases of children with PNS pathological type distribution and hormone sensitivity/resistance relationship respectively were:minor glomerular lesions (MCD) in18cases, the total number of cases of21.69%, hormone sensitive in15cases, accounting for83.33%, in children with steroid sensitive groups accounted for27.27%; hormone resistance in3cases, accounting for16.67%, in children with steroid resistance groups accounted for10.71%. Mesangial proliferative glomerulonephritis (MsPGN) in36cases, the total number of cases of43.37%, hormone sensitive in27cases, accounting for75%, in children with steroid sensitive groups accounted for49.09%; hormone resistance in9cases, accounting for25%, in children with steroid resistance groups accounted for32.14%. Membranous nephropathy (MN) in5cases, the total number of cases of6.02%, hormone sensitive in3cases, accounting for60%, in children with steroid sensitive groups accounted for5.45%; hormone resistance in2cases, accounting for40%, in children with steroid resistance groups accounted for7.14%. Focal segmental glomerulosclerosis (FSGS) in4cases, the total number of cases of4.82%, hormone sensitive in2cases, accounting for50%, in children with steroid sensitive groups accounted for3.63%; hormone resistance in2cases, accounting for50%, in children with steroid resistance groups accounted for7.14%. IgA nephropathy (IgAN) in7cases, the total number of cases of8.43%, hormone sensitive in3cases, accounting for42.86%, in children with steroid sensitive resistance group accounted for5.45%; in4cases, accounting for57.14%, in children with steroid resistance groups accounted for14.29%. Sclerosing glomerulonephritis (SGN) in4cases, the total number of cases of4.82%, hormone sensitive in1cases, accounting for25%, in children with steroid sensitive resistance group accounted for1.81%; in3cases, accounting for75%, in children with steroid resistance groups accounted for10.71%. Capillary in proliferative glomerulonephritis (EnPGN) in9cases, the total number of cases of1084%, hormone sensitive in4cases, accounting for44.44%, in children with steroid sensitive groups accounted for7.27%; hormone resistance in5cases, accounting for55.56%, in children with steroid resistance groups accounted for17.86%.4Renal tubulointerstitial lesion degree and hormone effect difference correlation analysis:adult and children’s renal tubulointerstitial lesion severity (mild, moderate, severe) and hormone sensitivity/resistance. There were significant differences. Patients with renal tubule lesion degree, the hormone resistance stronger. Adult and child urine RBP content and tubulointerstitial lesions by Spearman rank correlation analysis, results:adult R1=0.782, P<0.001; R2=0.721, P<0.001, description of urine RBP level and renal tubulointerstitial lesion degree there is a good correlation between higher RBP, urine, renal the greater the degree of functional impairment. Adult and children with steroid sensitive group and hormone resistance group urine RBP comparison, t test, P<0.001, there was significant difference.5The urine protein content and hormone effect comparative analysis:the adult, children with steroid-sensitive groups before and after treatment of24hour urinary protein aggregates, and tested by T, P<0.05, there were significant differences.24hours after treatment of urinary total protein decreased significantly. Adult and child hormone resistance groups before treatment and after treatment of24hour urinary protein aggregates, t test, P>0.05, no significant difference.6Hematuria associated with hormone therapy:relationship between adult and child with and without hematuria hematuria:hormone therapy (sensitivity/resistance) differences, by chi-square test, P<0.05, with significant difference. Adult patients with hematuria in189cases of urinary sediment count:uniform type of hematuria in31cases, including22cases of hormone sensitive, resistance in9cases; variant hematuria in166cases, including92cases of hormone sensitive, resistance in74cases. Hematuria is uniform and variant on hormone effect between the chi-square test, P>0.05, no significant difference in meaning. A uniform type of hematuria hormone sensitive group and steroid resistance group of urine red blood cell count, t test, P>0.05, no statistically significant difference; variant hematuria hormone sensitive group and steroid resistance group of urine red blood cell count, t test, P<0.05, there was significant’difference statistically significance. Children with only3cases of hematuria in patients with urinary sediment counting, without comparison.7Biochemical and immune indices and hormone effect between the related analysis:the adult children, serum BUN, Cr, TG, CH, TP, ALB, C3, C4and other indicators of content and hormone sensitivity/resistance group relationships were analyzed by t test and chi-square test analysis, P>0.05. No statistically significant significance of the differenceConclusion:1Adult patients with PNS,35-year-old patients the efficacy of glucocorticoid is more sensitive than the patients after35years of age。 The older of the children of patients with PNS, its sensitivity to glucocorticoids is downward trend. The men and women on the efficacy of glucocorticoid was no significant difference.2Adult and child patients with PNS typely of renal pathology is glomerular slight change disease (MCD) and mesangial proliferative (MsPGN)3Adult and child patients with PNS-based GC-sensitive pathological types are minor glomerular change disease (MCD) and mesangial hyperplasia (MsPGN), two pathological types. The pathological type of adult patients with PNS, GC resistance is mostly focal segmental sclerosis glomerulonephritis (of FSGS), mesangial proliferative (MN), minor glomerular lesions (MCD). The majority of the children PNS patients with mesangial proliferative lesions (MsPGN), endocapillary proliferative glomerulonephritis (EnPGN) with IgA nephropathy.4PNS patients, with tubulointerstitial damage on glucocorticoid,is poor sensitivity. Tubular greater on the degree of tubulointerstitial damage on glucocorticoid is sensitivity of the worse. Urine RBP levels of adult and child patients with PNS, hormone-sensitive group than steroid-resistant group. Was positively related to the degree of urine RBP and tubulointerstitial, the higher the concentration of urine RBP, the greater of the degree of tubulointerstitial damage. Therefore, changing in the urine RBP concentrations can predict tubulointerstitial damage extent and the efficacy of glucocorticoids.5Monitoring of f24-hour urine protein levels can predict the differences of the efficacy of glucocorticoids.6Adults and children PNS patients with hematuria, decreased the sensitivity to the glucocorticoid treatment. Variant hematuria in patients with glucocorticoid,the sensitivity is even worse.7Patients with PNS, serum BUN, Cr, TG and CH, the TP, ALB, C3, C4, all indices that the effect to glucocorticoid treatment have no significant difference.