Clinical,Pathology And Prognosis Analysis In Children With Steroid-resistant Nephrotic Syndrome

Objective:To analyze the clinical,pathological and follow-up data of children with steroid-resistant nephritic syndrome(SRNS),discussed the relationship between clinical classification,pathological type and steroid resistance,summarized the characteristics of children’s SRNS,explored factors that influence prognosis and provided guidance for the clinic.Methods:This study analyzed the clinical data(including gender,age of onset,course of disease,urine routine,blood biochemistry)of 92 children diagnosed with SRNS in our hospital from January 1,2014 to April 1,2018,renal pathology results,treatment options and treatment effects retrospectively.All children were grouped according to age,clinical type,pathological type,treatment plan,and treatment outcome.Results:1.Clinical and pathological types: 92 children with SRNS,including 68 males and24 females,the ratio of male to female was 2.8:1,and the onset age ranged from one month to 15 years and 9 months.The diseased age was 4.6±3.6 years old,including 64 cases of simple type and 28 cases of nephritis,accounting for 69.6% and 30.4%,respectively.Seventy-six of the 92 patients underwent B-ultrasound-guided renal biopsy.The results showed that there were 26 cases of focal segmental glomerulosclerosis(FSGS),18 cases of mesangial proliferative glomerulonephritis(MsPGN),22 cases of minimal change diseas(MCD),10 cases of other pathological types(including MN and EPGN),accounting for 34.2%,23.7%,28.9%,and 13.1%,respectively.2.Follow-up: There were 74 cases with complete follow-up data in 92 cases,including 64 cases of complete remission,2 cases of partial remission,6 cases of non-remission,2 cases of death,and the overall effective rate was 86.5%.3.Relationship between clinical and pathological types: 76 children with renal biopsy were divided into age group and clinical type.FSGS accounted for the highest proportionin all age groups and different clinical types under 12 years old.Pathological types showed that other types(including MN and EPGN)were more distributed in the nephritis type.4.Comparison of MCD and non-MCD: The non-MCD group was significantly more likely to have hematuria than the MCD group.5.Relationship between pathological type and prognosis: The prognosis of different pathological types was different,and the difference was statistically significant(P<0.05).Conclusions:(1)The pathological types of SRNS are mainly non-MCD,and the proportion of FSGS is the highest.(2)When SRNS combined with nephrogenic hematuria,the pathological type may be non-MCD.(3)The prognosis of children with SRNS was related to the pathological type,and the pathological type FSGS had the worst prognosis.