Protective Effect Of Estrogen On Renal Function In Female Patients With Unilateral Upper Urinary Tract Calculi Related Chronic Kidney Disease

Objective:To investigate the protective effect of Estrogen on renal function in female patients with unilateral upper urinary tract calculi related to chronic renal insufficiency.Methods:The study included patients with unilateral upper urinary tract calculi related to chronic renal insufficiency who attended Nanchong Central Hospital between January 2017 and January 2019.Patients were divided into pre-menopausal group and post-menopausal group according to whether they were menopausal or not,and the patient information was collected and registered.General information includes hospitalization number,age,anamnesis,menstrual condition,menopausal time,blood pressure,smoking,BMI,etc.Related indexes included creatinine,uric acid,cystatin C,urine cultivation,sex hormone levels,degree of hydronephrosis,obstruction time,operation modes,follow-up time,number of people whose renal function returned to normal,etc.The levels of preoperative eGFR were stratified,mild group(60ml/min/1.73m~2?eGFR<90ml/min/1.73m~2),moderate group(30ml/min/1.73m~2?eGFR<60ml/min/1.73m~2),and severe group(eGFR<30 ml/min/1.73m~2).The final indictor was whether the renal function returned to normal after operation(eGFR?90 ml/min/1.73m~2).The relationship between estrogen level and the recovery of renal function was analyzed after adjusting the other independent variables in the logistic regression equation.Results:(1)Of the 171 participants,163 patients completed the follow-up,including 67 premenopausal,96 postmenopausal,8 losted,3 lost the follow-up due to voluntary withdrawal,5 could not be contacted.All patients underwent the operation successfully without serious complications.(2)Univariate analysis showed that there were significant differences in age,time of obstruction,estrogen,follicle stimulating hormone and luteinizing hormone between the two groups(p<0.05).There was no significant difference in smoking,BMI,blood pressure,creatinine,cystatin C,uric acid,urine cultivation,degree of hydronephrosis,operation mode,follow-up time and preoperative eGFR(p>0.05).(3)The analysis of Logistic multivariate regression model showed that after adjusting the other independent variables,it was found that there were differences in the incidence of normal renal function at different estrogen levels in the total effect model.The incidence of renal function returning to normal in patients with low estrogen level was lower than that in patients with high estrogen level,and the difference was statistically significant RR=0.70,95%CI(0.59-0.81),p<0.05.After the preoperative eGFR stratification was included in the regression model,it was found that the incidence of renal function returning to normal in the mild and moderate estrogen group was lower than that in the high estrogen level,and the incidence in the mild group was higher than that in the moderate group.In mild group RR=0.66,95%CI(0.52-0.84),p<0.05;in moderate group RR=0.74,95%CI(0.59-0.93),p<0.05.In the severe group,there was no significant difference in the incidence of renal function returning to normal under different estrogen levels,RR=0.69,95%CI(0.40-1.18),p>0.05.Conclusions:(1)This study shows that,within a certain range,the level of physiological dose of estrogen has a protective effect on the renal function of female patients with calculi.(2)The protective effect of estrogen on renal function was different with different eGFR before operation.The protective effect of estrogen in mild group was higher than that in moderate group,but disappeared in severe group.