Changs And Significance Of CD80 And SuPAR In Patients With Minimal Change Disease And Focal Segmental Glomerulosclerosis

Background: Minimal change disease(MCD) is one of glomerular dise ases, whose main pathological changes is simple type nephrotic syndrome. Majority cases of focal segmental glomeruloscerosis(FSGS)mainly performed as nephrotic syndrome, and little cases of FSGS performed as chronic nephritis. It is very difficult to differentiate FSGS and MCD,because early in the disease,renal tubule atrophy and renal interstitial fibrosis are not obvious in FSGS patients and renal biopsy has its limitation, such as cannot take to border skin pulp tissues or the glomerular number is not enough. The relationship between MCD and primary FSGS has remained controversial, as some experts have considered the two entities to represent a continuum of one disease, whereas, others consider them separate entities. The two entities have similar clinical manifestations but different pathological characteristics and effects of prognosis. In recent years, research has found that elevated level of urinary CD80 is correlation with MCD, and that elevated level of serum suPAR is correlation with FSGS. we tested the levels of urinary CD80 and serum suPAR to explore whether it could be a useful and noninvasive way to differentiate between MCD and FSGS.Methods:1 A total of 78 subjects who were diagnosed in Second Hospital of Hebei Medical University, Department of Nephrology from March 2014 to August 2014 were collected and suffered renal biopsy. According to the pathological diagnosis, 43 cases were minimal change disease; 20 cases of focal segmental glomerulosclerosis were also included; Meanwhile, 15 cases of phase I of membranous nephropathy were collected as control group(All cases were with the exception of secondary factors).Collecting fresh urine 10 ml in the morning, packing in a clean EP tube for the test of urinary CD80. 3ml fasting blood were alse collected in the morining, centrifuged immedia tely upon blood coagulation(3000r/min, 10min), the supernatant was stored in refrigerator- 80 degrees and used to measure serum concentration of CD80 and suPAR.2 Specimens were collected before the use of corticosteroids or immuno sup pressive in patients with MCD and FSGS. Demographics, laboratory tests and physical examination were done by a specially-assigned person, including:age,gender,medical history,Medication history,serum A1 b, uri nary creatinine, 24-hour proteinuria and so on. Biochemical detections were done by clinical laboratory department.3 Urinary CD80?serum CD80?urinary su PAR and serum su PAR were measured using a commercially available ELISA kit.4 Measurement data which were normal distribution were expressed as x ±s, which were abnormal distribution were expressed as M(1/4,3/4) ? According to if the data were abnormal distribution or not,groups were compared using one-way ANOVA test and Mann-Whiteny non-parametric test. Further comparisons among groups which had equal variance used SNK analysis, or used Tamhane analysis. For enumeration data, groups were compared using analysis of variance. Matching between groups used Wilcoxon Rank test. We calculated the correlation between urinary CD80 and urinary su PAR using Spearman's correlation coefficient test. SPSS 13.0 statistical software was used to analyze the above mentioned data, in which process the significance was set at P<0.05.Results:1 General clinical data analysis showed that the differences of the age and gender among patients with MCD, FSGS and phase I of membranous nephropathy have no statistical significance(P>0.05).The level of serum creatinine in patients with FSGS(83.39±21.4umol/L) was higher than that in patients with MCD(70.59±30.1umol/L)(P<0.05).EGFR in patients with FSGS(80.01±39.43ml/min) was lower than that in patients with MCD(115.7 8±30.37ml/min)(P<0.05).While the difference of levels of eGFR between MCD group and control group had no statistical significance(P>0.05). 24 hours urinary protein levels among those three groups had no statistical significance(P>0.05).2 Urinary CD80: urinary CD80 in patents with MCD(7.88±0.95IU/ml) increased significantly compared to that in FSGS(5.79±1.69IU/ml)or to that in control group(6.42±1.83IU/ml)(P<0.001).But no significant differences of the level of urinary CD80 were seen between FSGS groups and control group(P=0.237).3 Serum CD80: The level of serum CD80 among those three groups had no statistical significance(P=0.965). MCD group:[7.49(6.83,9.47)IU/ml]?FSGS group :[7.58(6.85,8.59)IU/ml]?control group :[7.40(7.03,8.72)IU/ml].4 Urinary suPAR:The level of urinary suPAR between patients with MCD(30.30±2.48ng/ml) and patients with FSGS(31.41±3.05ng/ml)had no statistical significance(P=0.249).Compared with control group(27.13±3.69 n g/ml),the levels of urinary suPAR of patients in MCD group and FSGS group elevated significantly(P<0.001).5 Serum suPAR : The content of serum suPAR in patients with FSGS[42.28(38.49,143.77)ng/ml] was obviously higher than those in MCD patients[31.95(30.23,37.64)ng/ml] and those in control group[30.28(28.075,31.39)ng/ml](P<0.001).6 The correlation between urinary CD80 and su PAR:In patients with MCD, there was a good correlation between urinary CD80 and proteinuria(r=0.75,P<0.001),while there was no correlation between urinary CD80 and proteinuria in patients with FSGS(r=0.31,P=0.16).There were positive corr elations between urinary suPAR and proteinuria in patient with MCD(r=0.69,P<0.001)and FSGS(r=0.47,P ?=0.013).Conclusion: Urinary CD80 is elevated in MCD patients. On the contrary, serum suPAR is elevated significantly in FSGS patients. Detection of levels of urinary CD80 and serum suPAR may be a useful and noninvasive marker to differentiate between MCD and FSGS.