Predictive Value Of The Factors At Initial Stage For The Occurrence Of Refractory Nephrotic Syndrome In Children

Objective:Nephrotic syndrome is the most common glomerular disease in children.The main clinical manifestations are proteinuria,hypoalbuminemia,hyperlipidemia and edema.Glucocorticoid is commonly used in the treatment of primary nephrotic syndrome.After the routine dose of 8 ~ 16 weeks,the urine protein can be missed as soon as possible,so as to reduce further kidney damage and even achieve long-term relief.However,about50.0% ~ 60.0% of NS children are steroid-responsive nephrotic syndrome(SRNS),steroid-dependent nephrotic syndrome(SDNS)or frequently relapsing nephrotic syndrome(FRNS),they are all collectively referred to refractory nephrotic syndrome(RNS)that is after the use of the full dose hormone,the urinary protein continued to be recurrent.However,long-term application of hormones can cause side effects such as infection,hypertension,osteoporosis,etc.Therefore,it is one of the first problem in RNS treatment of children to determine the early factors of refractory nephropathy and to develop a reasonable treatment plan as early as possible to improve the long-term remission rate of RNS in children.The purpose of this study was to explore the clinical value of early pathogenesis factors in predicting the occurrence of refractory nephrotic syndrome in children.Methods:This study included 80 children who were admitted to the pediatric hospital of the second hospital affiliated to dalian medical university from October 2009 to December2017,and the children who were diagnosed with primary nephrotic syndrome(NS).After the treatment of full dose hormone therapy,according to the curative effect of full dose hormone therapy,we divided the children into refractory nephrotic syndrome and non-refractory nephrotic syndrome,The inclusion criteria of refractory nephropathy is in accordance with the guidelines for the diagnosis and treatment of hormone-sensitive,relapsed/dependent nephrotic syndrome(trial)in the nephrology group of the Chinese association of pediatrics in 2009.There were 37 cases of refractory nephropathy,43 cases of refractory nephropathy,including 56 males(70%)and 24 females(30%).The youngest children were aged 1 and 13,and the mean age was 4.8±3.17 years.Except for the diagnosis of lupus nephritis,purpura nephritis,hepatitis b virus associated nephritis and other secondary glomerular diseases.We collect and compare the factors at initial stage that is the children which sufferred nephrotic syndrome first time and without hormone or other immunosuppressive therapy,include the gender and age of patients and other index such as Residence(city,countryside);Eczema in the past;No history of upper respiratory tract infection 1 week before onset of disease;Peripheral venous blood Ig A,Ig G and Ig E before hormone therapy;The complement C3,C4 level,CD4/CD8 ratio,C-reactive protein,serum albumin,fibrinogen,blood sedimentation,and onset of disease were not accompanied with hematuria.Urinuria ?2 microglobulin;serum creatinine,Cys-C,prealbumin,blood ?2 microglobulin,urine microalbumin,24-hour urine protein quantification,Blood lipid related indicators include total cholesterol,triglycerides,high-density lipoprotein,low-density lipoprotein,apolipoprotein B;Edema duration(onset of edema before admission).Statistical analysis using SPSS19.00.Results:1.The index such as place of residence(rural),in the onset of the presence of eczema,have a great duration of respiratory tract infection,edema,and presence of blood in the urine differences between refractory nephrotic syndrome and non-nephrotic syndrome were no statistically significant difference(P > 0.05).2.In the early stage of the course of the disease,the clinical parameters of the twogroups were analyzed.Decreased Ig G level,decreased the prealbumin level,the high level of urinuria ?2 microglobulin,the high level of LDL-C between the refractory nephropathy group and the non-refractory group,there were statistically significant(P <0.05).And further into the logistic regression analysis,decreased serum Ig G level,decreased the prealbumin level,the high level of urine ?2 microglobulin,and the high level of LDL-C were all correlated to the early prognosis of refractory nephropathy.Conclusion:Decreased serum Ig G level,decreased the prealbumin level,the high level of ?2microglobulin,and the high level of LDL-C,all can be used as a course of early prediction factors associated with refractory nephrotic syndrome.