The Clinical Significance Of GRα/β On Peripheral Blood And Renal Tissues Of Adults With Idiopathic Membranous Nephropathy

Objective: To investigate the levels of glucocorticoid receptor(GR)alpha and beta subtype in peripheral blood and kidney tissues of adults with idiopathic membranous nephropathy(IMN)and to explore the relationship between the differential expression of glucocorticoid receptor subtype and the effect of steroid therapy alone,In order to provide a basis for clinical selection of treatment options.Method: A total of 46 patients diagnosed with IMN by renal biopsy from the Nephrology department of Third Hospital of Hebei Medical University from 1st September 2016 to 31 st December 2018 were enrolled in this study.They were treated with GC alone and signed informed consent.Blood samples were obtained before administration.All patients were treated with hormone alone for 8 weeks,and no remission patients were treated with tacrolimus.After treatment,there were 38 patients who were treated with hormone alone or with tacrolimus to achieve partial or complete remission.Among them,25 patients(effective group)who achieved partial or complete remission with steroids alone,13 patients who received partial or complete remission with tacrolimus(ineffiecacy group),and analyzed the levels of GRα and β subtypes between the two groups.Enzyme-linked immunosorbent assay(ELISA)were applied to detect the expression of GRα and GRβ on peripheral blood;The expression level of WT-1 、GRα and GRβ in renal tissues were detected respectively by indirect immunofluorescence(IIF)and used to analyze the relationship between the effects of GC therapy alone in adult IMN patients.Results:(1)There are both GRα and GRβ expression on peripheral blood and renal tissues of adults with IMN,especially GRα.However,compared with the two groups,the levels of GRβ in the peripheral blood and renal tissues of the effective group were significantly lower than those of the ineffiecacy group,and the ratio of GRα/GRβ was significantly higher than that of the ineffiecacy group(P>0.05),but there was no significant difference in GRα levels between the two groups(P>0.05).(2)Compared with the ineffiecacy group,there was no significant difference in the level of podocyte marker WT-1 in the effective group(P>0.05).Conclusions:There are differences in the expression of GRα and GRβ in peripheral blood and renal tissues of adult patients with IMN,which may be one of the causes of GC resistance.IMN patients with GRβ levels increased and GRα/GRβ ratio decreased may have poor therapeutic effects with steroid therapy alone,often requiring combined immunosuppressive therapy,while there is no significant difference in the expression of WT-1 in renal tissue between the two groups,indicating that there was no significant correlation between the glucocorticoid therapeutic effect and the degree of renal tissue damage.Monitoring the levels of GRα and GRβ in peripheral blood and kidney tissue can help to judge the effect of steroid therapy alone,and provide a basis for us to develop individualized treatment plans.