The Ana Lysis Of Clinical Pathological And Prognstic Relationship Of Primary Nephrotic Syndrome With Renal Insufficiency

Objective:This study aims to investigate the clinical?pathological features and prognosis in patients of primary nephrotic syndrome with renal insufficiency.Methods:In this retrospective study,94 patients who expressed as primary nephrotic syndrome with renal insufficiency before renal biopsy in nephrology department of Guangdong Provincial Hospital of Chinese Medicine were reviewed from 2012 to 2015.Information on demographic data,laboratory index,pathological feature,syndrome of Traditional Chinese Medicine and medicine treatments were collected.The SPSS 17.0 software was used to process statistical analysis.Results:Of all the patients of primary nephrotic syndrome with renal insufficiency,men accounted for 61.70%and women accounted for 38.30%,the ratio of male to female was 1.6:1.The age fluctuated in the range of 16 to 75,with an average age of 46.23 ± 17.17 years.There were 23 cases of minimal change disease(MCD)or glomerular minor lesions,31 cases of membranous nephropathy(MN),17 cases of focal segmental glomerulosclerosis(FSGS),14 cases of IgA nephropathy(IgAN),mesangioproliferative glomerulonephritis(MsPGN)in 6 cases,membrano-proliferative glomerulonephritis(MPGN)in 1 case,the other including proliferative sclerosing glomerulonephritis,focal sclerosing glomerulonephritis in 1 case;22 patients had acute renal tubular necrosis/injury(MCD 7 cases,FSGS 7 cases,MN5 cases,IgAN2 cases,MsPGNl cases),2 patients had acute interstitial nephritis(FSGS1 cases,MsPGN1 cases),56 patients were combined with varying degrees of renal tubular atrophy and renal interstitial fibrosis,the remaining 16 patients were not significantly renal tubulointerstitial injury(MCD 13 cases,IgAN 1 cases,MsPGN2 cases).13 patients received non-immunosuppressive therapy,the remaining 81 patients were treated with glucocorticoid or immunosuppressive therapy,there was no significant difference in the remission rate of the two groups.In the non-immunosuppressive treatment group,1 adverse events were observed once in the immunosuppressive group,while.there were 58 adverse events in the immunosuppressive group.The remission rate is higher in Chinese medicine decoction group compared with non-Chinese medicine decoction group.At the end of the follow-up,the renal function of 58 patients had recovered and 30 patients developed chronic renal insufficiency(eGFR less than 60 ml/(Min · 1.73m2)),univariate analysis showed that there were statistically significant differences in the age,systolic blood pressure,the history of hypertension,the level of renal function,serum albumin levels,uric acid,blood lipid levels,pathological types,and the degree of chronic renal injury.Conclusion:Primary nephrotic syndrome with renal dysfunction is not uncommon in clinical.The study found that it occurred mostly in the elderly and men,and there was no statistically significant difference between the immunosuppressive group and the non-immunosuppressive group in the remission of nephrotic syndrome,however,more adverse events were observed in the patients of immunosuppressive group,suggesting that accompanied by renal insufficiency,the patient's immunosuppressive regimen need to be carefully considered.Chinese medicine is probably beneficial to alleviate nephrotic syndrome and improve renal function.