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Objective:To investigate the correlation between the single nucleotide polymorphism (SNP) of the PLCE1 gene and children with primary nephrotic syndrome (PNS) in Guangxi Zhuang Autonomous Region. Methods:This study was a retrospective study, a case-control study was used to select 155 cases of PNS in Guangxi Zhuang children attending the Affiliated Hospital of Youjiang Medical University for Nationalities from January 2017 to January 2021 (PNS group), and 100 healthy Guangxi Zhuang children who were physically examined during the same period (healthy control group). Genotyping of PLCE1 SNP rs3765524, and rs2274223 were performed using the second-generation gene sequencing technology, and their correlation with the development of PNS was analyzed. Logistic regression analysis was used for correlation analysis, and Chi- square test or Fisher′ s exact probability method was used for comparison between groups. Results:(1)Compared with the healthy control group, PLCE1 rs3765524 was correlated with the risk of PNS in children of PNS group, and the TT genotype may reduce the risk of PNS in the co-dominant model ( OR=0.435, 95% CI: 0.238-0.794, P=0.007). There were no significant differences in the genotype of PLCE1 rs2274223 and the frequency of allele distribution between PNS group and healthy control group (all P>0.05). (2) A strong linkage disequilibrium existed at PLCE1 SNP rs3765524 and rs2274223.(3) There were no significant differences in the frequency of the distribution of haplotypes AC, AT and GT between PNS group and healthy control group (all P>0.05). Conclusions:PLCE1 SNP rs3765524 is correlated with the risk of PNS in children in Guangxi Zhuang Autonomous Region, and the TT genotype may be a protective factor for PNS in children in Guangxi Zhuang Autonomous Region.
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Primary nephrotic syndrome (PNS) is one of the common glomerular diseases in children.Glomerular disease treatment by anti-CD 20 monoclonal antibodies is currently a hot topic.There are three generations of anti-CD 20 monoclonal antibodies.As a representative of the first generation of anti-CD 20 monoclonal antibodies, Rituximab (RTX) has been proven effective in treating children with steroid-dependent/frequent-relapsing nephrotic syndrome (SDNS/FRNS). Ofatumumab (OFA) and Obinutuzumab (OBI) represent the second-and the third-generation anti-CD 20 monoclonal antibodies, respectively.OFA and OBI have showed good efficacy and safety in pediatric PNS.In this paper, clinical studies and applications of anti-CD 20 monoclonal antibodies in the treatment of children with PNS were reviewed, so as to provide a reference for the treatment of PNS in children.
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OBJECTIVES@#To study the expression of adipokines in children with primary nephrotic syndrome (PNS) before and after treatment and its correlation with blood lipids, as well as the role of adipokines in PNS children with hyperlipidemia.@*METHODS@#A total of 90 children who were diagnosed with incipient PNS or recurrence of PNS after corticosteroid withdrawal for more than 6 months were enrolled as subjects. Thirty children who underwent physical examination were enrolled as the control group. Venous blood samples were collected from the children in the control group and the children with PNS before corticosteroid therapy (active stage) and after urinary protein clearance following 4 weeks of corticosteroid therapy (remission stage). ELISA was used to measure the levels of adipokines. An automatic biochemical analyzer was used to measure blood lipid levels.@*RESULTS@#Compared with the control group, the children with PNS had a significantly lower level of omentin-1 in both active and remission stages, and their level of omentin-1 in the active stage was significantly lower than that in the remission stage (@*CONCLUSIONS@#Omentin-1 may be associated with disease activity, dyslipidemia, and proteinuria in children with PNS. Blood lipid ratios may be more effective than traditional blood lipid parameters in monitoring early cardiovascular risk in children with PNS.
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Child , Humans , Adipokines , Chemokines , Cytokines/metabolism , GPI-Linked Proteins/metabolism , Hyperlipidemias , Lectins/metabolism , Lipids , Nephrotic Syndrome/drug therapy , ProteinuriaABSTRACT
Objective To explore the clinical characteristics and correlation of adult primary nephrotic syndrome (PNS) with thyroid dysfunction,and early identify high-risk adult PNS patients with abnormal thyroid function by clinical data.Methods The clinical data of 101 adult PNS patients in Heji Hospital Affiliated to Changzhi Medical College from March 2015 to December 2017 were retrospectively analyzed.According to the thyroid function,the patients were divided into 2 groups:normal thyroid function group (67 cases) and thyroid dysfunction group (34 cases),including 9 cases with low triiodothyronine (T3) syndrome and 25 cases with subclinical hypothyroidism.The clinical data were compared,and the correlation between thyroid-stimulating hormone (TSH) and 24 h urinary protein,blood albumin and systolic blood pressure were analyzed.Results The incidence of thyroid dysfunction in adult PNS patients was 33.66％ (34/101),including 21 cases of membranous nephropathy,8 cases of minimal change disease,4 cases of IgA nephropathy and 1 case of membranoproliferative nephritis.The 24 h urinary protein in thyroid dysfunction group was significantly higher than that in normal thyroid function group:(8.76 ± 3.62) g vs.(6.96 ± 3.43) g,the albumin was significantly lower than that in normal thyroid function group:(21.82 ± 4.89) g/L vs.(24.49 ± 4.14) g/L,and there were statistical differences (P＜0.05 or ＜0.01);there was no significant difference in gender composition,age,course of disease,systolic blood pressure,diastolic blood pressure,body mass index,hemoglobin,platelet,creatinine,cystatin C,fasting blood glucose,total cholesterol,triacylglycerol,low-density lipoprotein cholesterol (LDL-C),fibrinogen,complement C3,IgG,IgM,IgA,PNS types and comorbidities between 2 groups (P＞0.05).The results of subgroup analysis results showed that the systolic blood pressure in subclinical hypothyroidism patients of thyroid dysfunction group was significantly higher than that in normal thyroid function group and the low T3 syndrome patients of thyroid dysfunction group:(148.16 ± 18.09) mmHg (1 mmHg =0.133 kPa) vs.(139.55 ± 18.77) and (127.78 ± 16.81) mmHg,the 24 h urinary protein was significantly higher than that in normal thyroid function group:(9.00 ± 3.64) g vs.(6.96 ± 3.43) g,the albumin was significantly lower than that in normal thyroid function group:(21.71 ± 5.26) g/L vs.(24.49 ± 4.14) g/L,and there were statistical differences (P＜0.05).Pearson correlation analysis result showed that TSH had no correlation with 24 h urinary protein and systolic blood pressure (r =0.193 and 0.072,P =0.053 and 0.472);however TSH was negatively correlated with albumin (r =-0.340,P =0.001).Conelusions In adult PNS patients with thyroid dysfunction,membranous nephropathy is the most common,followed by minimal change disease.The systolic blood pressure in PNS patients with subclinical hypothyroidism is significantly higher than that in patients with normal thyroid function and low T3 syndrome.In adult PNS patients,the lower the blood albumin is,the more likely they have thyroid dysfunction.
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To explore the risk factors of acute kidney injury(AKI)in adult primary nephrotic syndrome(PNS). Totally 185 patients with PNS were divided into AKI group(=51)and non-AKI group(=134).The demographic data and clinical and histological features at admission were compared between the two groups.The independent risk factors for AKI were evaluated by Logistics regression analysis. In 51 PNS patients with AKI,the common pathological types of AKI included minor glomerular abnormalities(29.4%),IgA nephropathy(25.5%),and membranous nephropathy(17.6%).The incidences of renal tubular casts and epithelial vacuoles in the AKI group were significantly higher than those in the non-AKI group(=0.004,=0.030).Males were more likely to suffer from AKI than females(=0.000).Patients in AKI group had significantly lower albumin level(=0.015)and higher levels of random urine protein,serum creatinine,uric acid,urea nitrogen,and triglyceride than non-AKI group(=0.030,=0.000,=0.000,=0.000,and =0.006),and polyserous and oliguria occurred more often in the AKI group(=0.000,=0.002).The AKI group had significantly higher incidences of high blood pressure and infections(=0.035,=0.000).Multivariate logistics regression analysis showed albumin(96 μmol/L),urea nitrogen(≥6.8 mmol/L),uric acid(≥400 μmol/L),diabetes,infection,and renal tubular casts were the independent risk factors for AKI. AKI complicating PNS is associated with a variety of factors.Its independent risk factors include the levles of albumin,serum creatinine,urea nitrogen,and uric acid,diabetes,infections,and renal tubular casts.
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Adult , Female , Humans , Male , Acute Kidney Injury , Creatinine , Kidney , Nephrotic Syndrome , Risk FactorsABSTRACT
Childhood primary nephrotic syndrome (PNS) is a challenging and persistent renal disorder. Corticosteroids is the first-line drug for the treatment of PNS. To reduce the side effects caused by the accumulation of corticosteroids dose and to maintain the remission state of the disease, immunosuppressants are applied to the treatment of PNS. However, many children with PNS still cannot get remission. Rituximab (RTX) is a novel immunosuppressive agent. In recent years, many studies have reported the treatment of PNS in children with RTX. This review analyzes the mechanism, course of treatment, dose, efficacy, and safety of RTX in the treatment of children with PNS.
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Objective@#To investigate the clinical significance of detection of urine renal injury biomarkers in children with primary nephrotic syndrome (PNS).@*Methods@#Seventy-nine children with PNS at the Department of Nephrology, Tianjin Children′s Hospital were enrolled from January to December 2016, who were given sufficient glucocorticoid for 4 weeks.According to the response to glucocorticoid, they were divided into steroid-sensitive nephrotic syndrome (SSNS) group (63 cases) and steroid-resistant nephrotic syndrome (SRNS) group (16 cases), then they were divided into simple type and nephritic type according to diagnostic criteria.Urinary levels of microalbuminuria (MAlb), transferrin (TfR), retinal binding protein (RBP), N-acetyl-β-D-glucosaminidase (NAG), α1-microglobulin (α1-MG) and β2-microglobulin (β2-MG) were measured in the children before and after treatment, and the data were analyzed by the statistical method.@*Results@#Before treatment, the levels of RBP, NAG, α1-MG and β2-MG in the SSNS group [0.91(1.80) mg/L, 28.00(31.5) U/L, 8.40(14.2) mg/L, 0.45(0.35) mg/L]were lower than those in SRNS group[3.94(4.82) mg/L, 37.10(18.20) U/L, 11.10(21.42) mg/L, 0.66(1.41) mg/L], and the differences were statistically significant (all P<0.05); After treatment, the MAlb, TfR, RBP, NAG, α1-MG, β2-MG in the SSNS group [14.10(5.60) mg/L, 0.40(1.60) mg/L, 0.26(0.38) mg/L, 7.90(9.10) U/L, 2.00(4.40) mg/L, 0.27(0.35) mg/L] were lower than those before treatment[MAlb: 1 704.00(1 995.60) mg/L, TfR: 142.10(81.90) mg/L] and those after treatment in the SRNS group[557.90(1 857.17) mg/L, 117.40(102.10) mg/L, 4.19(5.15) mg/L, 38.80(32.43) U/L, 10.85(16.60) mg/L, 0.63(0.91) mg/L], and the differences were statistically significant (all P<0.05). However, before and after treatment, except for MAlb[before treatment: 2 258.75(2 028.43) mg/L], the indicators in the SRNS group were not significantly improved.Before treatment, the RBP in the SRNS group was significantly higher than that in the SSNS group in children with simple type PNS, and the RBP, NAG, α1-MG and β2-MG in the SRNS group were significantly higher than those in the SSNS group in children with nephritic type PNS (all P<0.05). According to receiver operating characteristic curve, there were obvious differences in the urinary levels of RBP, NAG and β2-MG, and area under curve(AUC) was 0.858, 0.837 and 0.679, respectively, all of which were <0.9, so the value of diagnosis was not high.Logistic regression analysis was used to identify RBP and NAG as influencing factors and to establish a model.Through the combined detection of these two indicators, the diagnostic value was higher (AUC was 0.956), and when the diagnostic sensitivity was 93.8%, the specificity could reach 82.5%.@*Conclusions@#Urinary RBP, NAG, α1-MG and β2-MG can early reflect tubular interstitial impairment in children with PNS, especially SRNS.Combined detection of RBP and NAG has certain value in predicting the efficacy of glucocorticoid.
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Objective@#To systematically analyze the risk factors for urinary tract infection (UTI) in children with primary nephrotic syndrome (PNS), in order to provide scientific evidence for clinical prevention.@*Methods@#Eight databases including PubMed, Embase, Cochrane Library, Web of Science, China National Knowledge Infrastructure, WanFang Database, Chinese Science and Technology Periodical Database and Chinese Biological Medical Literature Database were retrieved for the case-control studies on PNS complicated with UTI in children.According to the inclusion and exclusion criteria, eligible studies were selected for meta-analysis by using RevMan 5.3 software.@*Results@#Finally, 12 case-control studies were included, 917 children in the case group and 2 784 children in the control group.Compared with children without UTI, statistically significant difference existed in children with UTI of elevated 24-hour urine protein [standardized mean difference (SMD)=0.45, 95% CI: 0.02-0.88], decreased serum albumin (SMD=-1.06, 95%CI: -1.14--0.97), elevated serum cholesterol [weighted mean difference (MD)=2.28, 95%CI: 1.61-2.95], elevated serum low density lipoprotein (SMD=0.57, 95%CI: 0.37-0.77), decreased plasma IgG (SMD=-0.76, 95%CI: -0.94 to-0.58), elevated plasma IgM (MD=0.28, 95%CI: 0.11-0.46), high-dose hormone (MD=0.75, 95%CI: 0.58-0.92), and long time hormone use[<15 d odds ratio (OR)=-0.20, 95%CI: 0.10-0.42; ≥15 d OR=5.00, 95%CI: 2.38-10.50].@*Conclusions@#Massive proteinuria, hypoalbuminaemia, hypercholesterolemia, high level of low density lipoprotein, decreased plasma IgG, high-dose hormone and long time hormone use are risk factors for UTI in children with PNS.
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Primary nephrotic syndrome(PNS)is a common renal disease in children and the pathogenesis has not been clarified, but it is considered to be related to cellular immune dysfunction.We collected the reported cytokines associated with PNS and reviewed the resources and the involving pathogenesis of the cytokines.We hope to help to clarify the possible pathogenesis of PNS and to develop new treatments for PNS patients.
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Objective@#To explore the clinical characteristics of glucocorticoid induced eye damage in children with primary nephrotic syndrome.@*Methods@#The clinical data of steroid-induced high intraocular pressure or cataract in 49 children who were from Zhengzhou Children′s Hospital with primary nephrotic syndrome admitted from September 2016 to April 2018 were analyzed retrospectively in order to observe the relationship between relevant eye damage and clinical medication.@*Results@#There were 37 boys and 12 girls in the 49 cases, of which the average age of onset was (7.6±3.0) years old, and among them there were 22 cases with glucocorticoid high intraocular pressure, 19 cases with glucocorticoid cataract, 8 cases with glucocorticoid high intraocular pressure combined with cataract, but no glaucoma in 49 cases.The shortest time of using glucocorticoid was 15-3 240 days[(863.33±871.46) days]; the cumulative dose of glucocorticoid was (7 865±3 691.66) mg/m2, the left eye pressure was (26.68±5.95) mmHg(1 mmHg=0.133 kPa) and the right eye pressure was (27.71±5.82) mmHg.There was no significant correlation between glucocorticoid using time, cumulative dose and high intraocular pressure(r=-0.158, -0.264, -0.237, -0.361, all P>0.05). All the 19 patients with glucocorticoid cataract and 8 patients with glucocorticoid high intraocular pressure combined with cataract presented posterior capsular opacity, including 23 males and 4 females, and their time of using glucocorticoid was(1 296.67±903.35)days, who were followed up continuously.@*Conclusions@#Glucocorticoid-induced high intraocular pressure and cataract should be paid attention to by clinicians.Once high intraocular pressure or cataract occurs, the dosage of glucocorticoid should be gradually reduced or stopped, at the same time, ophthalmologic treatment should be actively performed to avoid serious eye diseases.
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Objective To systematically analyze the risk factors for urinary tract infection( UTI)in children with primary nephrotic syndrome(PNS),in order to provide scientific evidence for clinical prevention. Methods Eight databases including PubMed,Embase,Cochrane Library,Web of Science,China National Knowledge Infrastructure, WanFang Database,Chinese Science and Technology Periodical Database and Chinese Biological Medical Literature Da-tabase were retrieved for the case-control studies on PNS complicated with UTI in children. According to the inclusion and exclusion criteria,eligible studies were selected for meta-analysis by using RevMan 5. 3 software. Results Finally, 12 case-control studies were included,917 children in the case group and 2 784 children in the control group. Com-pared with children without UTI,statistically significant difference existed in children with UTI of elevated 24-hour urine protein[ standardized mean difference( SMD )= 0. 45,95% CI:0. 02 - 0. 88 ],decreased serum albumin (SMD= -1. 06,95% CI:-1. 14 - -0. 97),elevated serum cholesterol[ weighted mean difference(MD)=2. 28, 95% CI:1. 61-2. 95],elevated serum low density lipoprotein(SMD=0. 57,95% CI:0. 37-0. 77),decreased plasma IgG(SMD= -0. 76,95% CI:-0. 94 to-0. 58),elevated plasma IgM(MD=0. 28,95% CI:0. 11-0. 46),high-dose hormone(MD=0. 75,95% CI:0. 58-0. 92),and long time hormone use[<15 d odds ratio(OR)= -0. 20, 95% CI:0. 10-0. 42;≥15 d OR=5. 00,95% CI:2. 38-10. 50]. Conclusions Massive proteinuria,hypoalbuminae-mia,hypercholesterolemia,high level of low density lipoprotein,decreased plasma IgG,high-dose hormone and long time hormone use are risk factors for UTI in children with PNS.
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Objective To explore the clinical characteristics of glucocorticoid induced eye damage in children with primary nephrotic syndrome. Methods The clinical data of steroid－induced high intraocular pressure or cataract in 49 children who were from Zhengzhou Children′s Hospital with primary nephrotic syndrome admitted from September 2016 to April 2018 were analyzed retrospectively in order to observe the relationship between relevant eye damage and clinical medication. Results There were 37 boys and 12 girls in the 49 cases,of which the average age of onset was (7. 6 ± 3. 0)years old,and among them there were 22 cases with glucocorticoid high intraocular pressure,19 cases with glucocorticoid cataract,8 cases with glucocorticoid high intraocular pressure combined with cataract,but no glaucoma in 49 cases. The shortest time of using glucocorticoid was 15 －3 240 days[(863. 33 ± 871. 46)days];the cumulative dose of glucocorticoid was(7 865 ± 3 691. 66)mg/m2 ,the left eye pressure was(26. 68 ± 5. 95)mmHg(1 mmHg﹦0. 133 kPa)and the right eye pressure was(27. 71 ± 5. 82)mmHg. There was no significant correlation between glu﹣cocorticoid using time,cumulative dose and high intraocular pressure( r﹦ －0. 158,－0. 264,－0. 237,－0. 361,all P＞0. 05). All the 19 patients with glucocorticoid cataract and 8 patients with glucocorticoid high intraocular pressure combined with cataract presented posterior capsular opacity,including 23 males and 4 females,and their time of using glucocorticoid was(1 296. 67 ± 903. 35)days,who were followed up continuously. Conclusions Glucocorticoid－in﹣duced high intraocular pressure and cataract should be paid attention to by clinicians. Once high intraocular pressure or cataract occurs,the dosage of glucocorticoid should be gradually reduced or stopped,at the same time,ophthalmologic treatment should be actively performed to avoid serious eye diseases.
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Primary nephrotic syndrome (PNS) is a common renal disease in children and the pathogenesis has not been clarified,but it is considered to be related to cellular immune dysfunction.We collected the reported cytokines associated with PNS and reviewed the resources and the involving pathogenesis of the cytokines.We hope to help to clarify the possible pathogenesis of PNS and to develop new treatments for PNS patients.
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Objective; To explore the clinical efficacy and safety of beraprost sodium (BPS) combined with glucocorticoid (GC) and (or) immunosuppressive agents in the treatment of the patients with primary nephrotic syndrome (PNS), and to provide evidence for its application in the treatment of PNS. Methods; Eighty-six patients diagnosed as PNS definitely were selected. They were treated with GC and (or) immunosuppressive agents and were divided into BPS group (administrated with BPS, ra=42) and control group (administrated with dipyridamole or aspirin, n-) according to their willing to the acceptance of different anti-platelet treatment regimens. The relevant laboratory indexes of the patients in two groups before and after treatment were analyzed, and the effective rate, incidence of complications and drug adverse reactions of the patients in two groups were compared. Results; Comparedwith control group, the urinary protein levels of the patients in BPS group at the 1st and 6th months after treatment were significantly decresed (P<0. 05) and the serum albumin (ALB) levels of the patients in BPS group were significantly increased (P<0. 05); the levels of fibrinogen (FIB) and D-dimer (DD) of the patients in BPS group at the 3rd, 6th and 12th months after treatment were significantly decreased (P<0. 05 or P<0. 01). Compared with control group, the systolic blood pressure (SBP) and diastolic blood pressure (DBP) of the patients in BPS group at the 1st month after treatment were decreased significantly (P<0. 05). The cholesterol (TC) level and total effective rate of the patients in BPS group at the 6th month after treatment were higher than those in control group (P<0. 05). Compared with control group, the incidence of elevation of blood pressure of the patients with normal basal blood pressure in BPS group was significantly decreased (P<0. 05); the incidence of headache and dizziness was significantly increased (P<0. 05). Conclusion: The safety of BPS combined with GC and (or) immunosuppressive agents in treating the PNS patients is higher and superior to the conventional antiplatelet agents.
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Objective To investigate the expression changes of soluble urokinase-type plasminogen activator receptor(suPAR)and soluble triggering receptors expressed by myeloid cell-1(sTREM-1)in serum of children with primary nephrotic syndrome(PNS)and their clinical significance.Methods A total of 92 cases of newly diag-nosed PNS children were selected in Central Hospital of Yidu Affiliated to Weifang Medical College from June 2014 to September 2016.According to presence or absence of acute tubular necrosis,they were divided into acute renal injury group(27 cases)and non-acute renal injury group(65 cases).According to pathology type,they were divided into mesangial proliferative glomerulonephritis(30 cases),focal segmental glomerulosclerosis(23 cases),membranous ne-phropathy(18 cases),minimal change disease(14 cases)and membrane proliferative glomerulonephritis(7 cases).In the same period,45 healthy children were selected as the healthy control group.The clinical data were collected.The serum levels of suPAR and sTREM-1 were measured by adopting enzyme-linked immunosorbent assay(ELISA). Results The levels of total cholesterol(TC),triglycerides(TG),uric acid(UA),urinary protein/creatinine,24 h urinary protein,urinary N-acetyl-β-glucosaminidase(NAG)and β2-microglobulin(MG)in children with PNS were higher than those in the healthy control group,while serum albumin(ALB)was lower than that in the healthy con-trol group,and the differences were statistically significant(all P<0.05).The serum levels of suPAR and sTREM-1 in PNS patients were(133.09 ± 62.48)ng/L and(79.29 ± 34.68),respectively,which were significantly higher than those in the healthy control group[(31.11 ± 11.61)ng/L and(25.08 ± 8.10)ng/L](t=51.714,49.435;all P=0.000).The serum levels of suPAR and sTREM-1 in acute renal injury group were(188.82 ± 32.21)ng/L and (109.11 ± 24.78)ng/L,respectively,which were significantly higher than those in non -acute renal injury group [(75.96 ± 28.69)ng/L and(52.23 ± 14.07)ng/L]and healthy control group[(31.11 ± 11.61)ng/L and (25.08 ± 8.10)ng/L](F=16 739.607,10 487.256,all P=0.000).The serum levels of suPAR and sTREM-1 in children with focal segmental glomerulosclerosis and membrane proliferative glomerulonephritis were higher than those with minimal change disease,membranous nephropathy and mesangial proliferative glomerulonephritis,and the differences were statistically significant(all P<0.05).Pearson correlation analysis results showed that the serum levels of suPAR and sTREM -1 were positively correlated with TC,TG,urinary protein/creatinine,24 h urinary protein, urinary NAG and β2-MG(all P <0.05),while negatively correlated with ALB(P <0.05). Conclusions The serum levels of suPAR and sTREM-1 are elevated in children with PNS,and which are related with acute renal injury and pathological type,which can reflect the degree of renal tubular disease and kidney function to a certain extent.
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Objective To investigate the changes of plasma protein Z and coagulation factor Ⅷ activity in children with primary nephrotic syndrome.Methods 94 children with primary nephrotic syndrome were se-lected as the observation group,and 63 healthy children were selected as the control group.The blood samples of peripheral blood were collected from the study group,and plasma protein Z and coagulation factor Ⅷ were measured by enzyme linked immunosorbent assay.Enzyme linked immunosorbent assay was used to measure plasma protein Z and coagulation factor Ⅷ.The changes of plasma protein Z and coagulation factor Ⅷ in the two groups were compared,and the changes of plasma protein Z and coagulation factor Ⅷ in the acute and re-covery phase,and the correlation between plasma protein Z and coagulation factor Ⅷ were observed.Results The observation group of plasma protein Z level is lower than the control group,blood coagulation factor Ⅷlevels higher than the control group,and the difference was statistically significant(P<0.05);plasma protein Z level in acute stage is lower than the recovery period,and coagulation factor Ⅷ level is higher than the recov-ery period,the differences were statistically significant(P<0.05);plasma protein Z and coagulation factor Ⅷwas negatively correlated.Conclusion The plasma protein Z level in children with primary nephrotic syn-drome is significantly reduced,and the activity of coagulation factor Ⅷ is significantly increased.Detection of plasma protein Z and coagulation factor Ⅷ level can predict primary nephrotic syndrome in children.
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<p><b>OBJECTIVE</b>To provide an objective reference for the syndrome types of Chinese medicine (CM) associated with pediatric primary nephrotic syndrome (PNS).</p><p><b>METHODS</b>A cross-sectional study was performed. Data on clinical symptoms, CM syndrome types, biochemical indices, and medications used were collected from 98 children with PNS. Then, the correlation between CM syndromes and biochemical indices, as well as medications used, was analyzed.</p><p><b>RESULTS</b>The four most common symptoms in children with PNS were brown urine, red tongue, excessive sweating, and swelling of the face and limbs. The syndromes of qi deficiency of Fei (Lung) and Shen (Kidney) (FSQD) and yin deficiency of Gan (Liver) and Shen (GSYD) were the most common main CM syndrome types. FSQD syndrome score correlated significantly with the total cholesterol level, urine protein/creatinine ratio, and urine IgG and albumin levels (P<0.01 or P<0.05). The use of maintenance glucocorticoids combined with immunosuppressive agents correlated with FSQD syndrome, and the use of maintenance glucocorticoids alone correlated with GSYD syndrome (P<0.05).</p><p><b>CONCLUSION</b>Two of the most common CM syndrome types were FSQD and GSYD syndromes. FSQD syndrome may be caused by some factors related to lipid levels, protein loss, and the use of immunosuppressive agents. The use of maintenance glucocorticoids may cause GSYD syndrome.</p>
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Adolescent , Child , Child, Preschool , Female , Humans , Infant , Male , Demography , Drugs, Chinese Herbal , Therapeutic Uses , Medicine, Chinese Traditional , Nephrotic Syndrome , Drug Therapy , TherapeuticsABSTRACT
Tacrolimus is commonly used in the treatment for the refractory primary nephrotic syndrome (PNS) in the pediatric patients. Data were retrospectively obtained from 100 children with 357 tacrolimus trough concentrations in our center between May 2010 and March 2016. Information of age, sex, body weight, drug dose, co-therapy medications, laboratory tests and sampling time were collected. The population pharmacokinetic model was developed using nonlinear mixed effect modeling (NONMEM) software. A one-compartment model with first-order absorption and elimination best described the data. The population estimate of apparent clearance (CL/F) and apparent volume of distribution (V/F) was 6.54 L·h-1 and 86.2 L, respectively. Body weight (WT, kg), daily dose of tacrolimus (DD, mg·day-1) and co-therapy azole antifungal agent have a significant impact on the CL/F. The final PPK model of CL/F was:CL/F=6.54×((WT)/25)K×((DD)/1.5)0.293×0.657Azole,K=(WT-30.9)/(WT-30.9+10.4-30.9). When combined with azole antifungal agents, Azole was 1, whereas vice versa was 0. This is the first PPK study of tacrolimus conducted in pediatric patients with PNS, which may facilitate individualized drug therapy of tacrolimus.
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Objective To explore the changes of bone metabolism in children with newly diagnosed primary nephrotic syndrome (PNS). Methods Forty-five children diagnosed with PNS from February 2013 to July 2016 were selected into the PNS group, and 30 healthy children in the same period were enrolled in the control group. The serum calcium, phosphorus, bone alkaline phosphatase (BALP), osteocalcin (BGP), type I collagen cross linked C terminal peptide (CTx) and serum tartrate resistant acid phosphatase 5b (TRACP), and 25-(OH)D were measured and compared between two groups. Bone mineral density (BMD) was measured by ultrasound. Results The levels of BALP, CTx, and 25-(OH)D in the PNS group were higher than those in the control group, and the levels of BGP, TRACP, blood calcium, and BMD (Z- scores) in the PNS group were lower than those in the control group, and the differences were statistically significant (P<0.01). There was no significant difference in serum phosphorus between two groups (P>0.05). Conclusions Abnormal bone metabolism is found in children with newly diagnosed PNS and its manifestations include calcium loss, reduced bone formation, and increased bone resorption.
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Objective To investigate the relationship between serum levels of PCT and neutrophil CD64 contents with the effect of hormone therapy and complications in the patients with primary nephrotic syndrome.Methods Sixty-five patients with primary nephrotic syndrome in our hospital from September 2015 to September 2016 were selected as the research subjects,all cases were treated with hormonal therapy,the serum levels of PCT and neutrophil CD64 were detected and their relationship with the curative effect and complications of nephrotic syndrome was analyzed.Results According to the PCT and neutrophil CD64 median levels,the cases were divided into the high level group and low level group,the results found that serum creatinine,serum protein,urine protein and pathological types had no statistical difference between the high level group and low level group.The hormone sensitivity had 15 cases in the patients with high PCT level,which was significantly lower than 21 cases in the patients with low PCT level;the hormone sensitivity had 14 cases in the patients with high neutrophil CD64 level,acute renal failure,infection and thrombus in the patients with high PCT level had 8,10,6 cases,which were significantly lower than those in the patients with low PCT level;acute renal failure,infection and thrombus in the patients with high neutrophil CD64 level had 7,11,6 cases,which were significantly higher than those in the patients with low neutrophil CD64 level (P<0.05).Conclusion The levels of serum PCT and neutrophil CD64 are significantly correlated with the therapeutic effect and clinical prognosis in the patients with nephrotic syndrome.