Clinical Therapy Of Calcitriol Combined With Valsartan In The Treatment Of Nephritis Syndrome

Objective: To investigate the serum levels of 25(OH)D in patients with nephritis syndrome and to further investigate the effect of calcitriol combined with valsartan in the treatment of nephritis syndrome.Methods:From October 2016 to June 2017,56 patients with nephritis syndrome hospitalized in Department of Nephrology,People's Hospital of Guangxi Zhuang Autonomous Region were enrolled.The pathological types of kidney were Ig A nephropathy,Nephropathy,mild mesangial proliferative glomerulonephritis,minimal change disease.(2)The serum 25(OH)D levels of patients with nephritis syndrome were measured and compared with 60 healthy volunteers.In accordance with the principle of randomized control 58 nephritis syndrome patients were divided into control group and observation group,and 28 cases each.The control group were given valsartan(80mg/day)orally,the observation group were given calcitriol(0.25ug/day)combined with valsartan(80mg/day)orally.The treatment is 24 weeks and the patients were regulately follow-up by every month.The levels of 25(OH)D,serum calcium,phosphorus,PTH,serum albumin,serum creatinine,e GFR,urinary protein in 24 hours and T lymphocyte subsets before andafter treatment were measured.The differences between the observation group and the control group after treatment were compared.Results:(1)The incidence of vitamin D insuffieiency/deficiency in patients with nephritis syndrome was 69.64%,Serum levels of 25(OH)D in patients with nephritis syndrome were lower than those in healthy controls(P <0.001),and further Pearson correlation analysis showed that 25(OH)D level was negatively correlated with 24-hour urinary protein(r=-0.366,P=0.006),25(OH)D level was positively correlated with serum albumin(r=0.364,P=0.006),25(OH)D level was positively correlated with urea nitrogen(r=0.279,P=0.037),25(OH)D level was negatively correlated with cholesterol(r=-0.271,P=0.032),25(OH)D level was negatively correlated with low densith lipoprotein(r=-0.398,P= 0.002),25(OH)D levels was negatively correlated with mean arterial pressure(r=-0.264,P=0.050),further multiple linear stepwise regression analysis showed that the factors affecting the level of Vit D in nephritis syndrome maybe 24 hour urinary protein quantitation(?=-0.004,P=0.028),urea nitrogen(?= 3.253,P= 0.03),low density cholesterol(? =-5.115,P = 0.001).(2)After 24 weeks of treatment,the levels of serum albumin increased after treatment,24 hours proteinuria quantitation and the hematuria rate decreased in the control group,the difference was statistically significant(P<0.05),there were no statistical difference between serum creatinine,e GFR,T lymphocytes subgroups and proteinuria rate before and after treatments in the control group(P>0.05).After 24 weeks of treatment,the level of serum albumin,the level of 25(OH)D and serum calcium increased,24 hours proteinuria quantitation,proteinuria rate,hematuria rate and Cys C level decreased in the observation group,the difference wasstatistically significant(P<0.05),there were no significant difference in serum phosphorus,PTH,serum creatinine,e GFR,T lymphocyte subsets before and after treatments in the observation group(P>0.05).(3)There was no significant difference between the two groups before treatment(P> 0.05).After 24 weeks of treatment,24-hour urinary protein quantitation,urea nitroge and Cys C level in observation group were lower than those in the the control group,25(OH)D levels,serum albumin levels in observation group were higher than those in the the control group,the difference was statistically significant(P<0.05),and serum calcium,serum phosphorus,PTH,serum creatinine,e GFR,T lymphocyte subsets,proteinuria rate and hematuria rate were not statistically different(P> 0.05).(4)During the course of treatment,no adverse reactions were found in both groups.Conclusions:(1)The lack/deficiency of 25(OH)D levels is prevalent in patients with nephritis syndrome.(2)The influencing factors of Vit D level in patients with nephritis syndrome may be 24-hour urinary protein quantification,urea nitrogen,and low density cholesterol.(3)Calcitriol combined with Valsartan in the treatment of nephritis syndrome is more effective than valsartan alone to reduce urine protein,increase serum albumin level and has important significance for kidney protection.