Value Of Diurnal Change Rate Of Proteinuria In Judging The Curative Effect Of Primary Nephrotic Syndrome

Part Ⅰ Diurnal Change Rate of Proteinuria in Primary Nephrotic SyndromeObjective This part of the experiment is to observe the characteristics of proteinuria excretion during the day(7: 00-19: 00)in patients with primary nephrotic syndrome.It is revealed that proteinuria excretion is rhythmic and its maximum variation value during the daytime.Methods 40 patients with primary nephrotic syndrome were randomly included,who hospitalized in the 900 th Hospital of the China Uniformed Security Forces in 2012.Collected at 6 points in a day(before breakfast(7:00),2 hours after breakfast(9:00),before lunch(11:00),2 hours after lunch(13:00),and before dinner(17 : 00),2 hours after dinner(19:00)),the urine microalbumin and creatinine ratio(ACR)were measured and compared.Results1.There were statistically differences in ACR values at six points(P<0.001).The average daily ACR variability was 103%(59%,329%).The ACR was lowest before breakfast and highest 2 hours after dinner.2.Compared of ACR before three meals,the ACR value at each point was statistically different(P = 0.017).ACR before breakfast <ACR before lunch <ACR before dinner;Compared with the 2 hour after three meals,the ACR value at each point was also statistically different(P = 0.001),ACR after breakfast <ACR after lunch <ACR after dinner.3.For before and after three meals,compared with ACR before and after breakfast and lunch,there was no statistical significance(P morning =0.533,P lunch =0.771).However,compared with ACR before and after dinner,it was statistically significant(P evening =0.024).Comparison between morning,middle and evening,ACR morning < ACR lunch< ACR evening and the difference was statistically significant(P <0.01).ConclusionThere is change rate existed in the urine proteins in patients with primary nephrotic syndrome,and it is lowest before breakfast and highest in 2 hours after dinner.Part Ⅱ Value of Diurnal Change Rate of Proteinuria in Judging the Curative Effect of Primary Nephrotic SyndromeObjectiveIt is to investigate the value of diurnal change rate of proteinuria in judging the curative effect of primary nephrotic syndrome.Methods122 patients with primary nephrotic syndrome were randomly included,who visited our hospital from January 2012 to August 2019.Those people were divided into nonrefractory and refractory groups according to the efficacy of hormones and / or immunosuppressive.Two groups of patients were taken urine before breakfast(7:00)and 2 hours after dinner(19:00)during the day,and ACR were measured.ACR and clinical data were compared between the two groups.Results1.Two groups were compared,there were not statistically significant in gender,BMI,systolic blood pressure,diastolic blood pressure,basal serum creatinine,albumin,hemoglobin,urea nitrogen,uric acid,fasting blood glucose,triglycerides,cholesterol,low-density lipoprotein and high-density lipoprotein(P > 0.05),while the refractory group was older,which were statistically significant compared with the non-refractory group(P <0.05).2.The increase rate of ACR in the refractory group was 0.71(0.34,1.55),which was higher than that in the non-refractory group with 0.36(-0.04,0.46)(P <0.05),the difference of which was statistically significant.3.Multivariate Logistic regression analysis showed that there was no significant correlation between serum creatinine,age and curative effect,but the increase rate of ACR was a risk factor for the curative effect of primary nephrotic syndrome(P = 0.004,OR = 0.185,95% CI = 0.059 ~ 0.584).4.ROC curve analysis showed that the increase rate of ACR had a good judgment value for the curative effect of primary nephrotic syndrome(AUC = 0.773,95% CI = 0.690 ~ 0.855,P <0.01).When the cut-off value was 0.56,the sensitivity reached 58.8% and the specificity reached 100%.5.In the non-refractory group,the increase rate of ACR was significantly negatively correlated with the remission time(r =-0.356,P <0.01).6.In the refractory group,56% were membranous nephropathy,28% were focal segmental glomerulosclerosis,4% were micropathic nephropathy,and 4% were focal proliferative glomerulonephritis.Conclusion1.The increase rate of ACR is a risk factor for the curative effect of primary nephrotic syndrome.It can be used as a simple and practical clinical indicator to predict the curative effect of primary nephrotic syndrome.When the increase rate of ACR is < 0.56,it often indicates that the disease has a poor curative effect;2.The ACR increase rate is significantly negatively correlated with the remission time,that is,the greater the ACR increase rate,the shorter the remission time of the primary nephrotic syndrome;3.Most patients with poor curative effect are membranous nephropathy and focal segmental glomerulosclerosis,accounting for 84%.