The Study Of Relapse Risk Factors And Prognosis In Children With Primary Nephrotic Syndrome

ObjectiveTo investigate the risk factors of recurrent Primary Nephrotic Syndrome(PNS)in children,and to understand the prognosis of recurrent children,in order to provide the basis for clinical workers to detect high-risk children in early stage,formulate reasonable treatment strategies in early stage,and improve the quality of life and prognosis of children.MethodsBy retrospective investigation method,children who were first diagnosed with primary nephrotic syndrome in the First Affiliated Hospital of Nanchang University from January 2011 to October 2019 were selected as research objects,and a follow-up of at least three years was conducted.All children who met the inclusion criteria were divided into a recurrence group and a non-recurrence group according to the recurrence situation.General data and laboratory test indicators of the relapsing group and the non-relapsing group were compared.SPSS26.0 software was used for single factor analysis,and binary logistic regression analysis was carried out on the obtained statistically significant variables.Rank sum test was performed for grade data(prognosis).Results1.The general situation of 169 children with PNS:(1)Gender: male children accounted for the vast majority,with a male to female ratio of 10:3;(2)Age: The median age of onset was 5.00 years(1-16 years),and the peak age of onset was early school age;(3)Season: autumn and winter accounted for a higher proportion of the overall incidence season;(4)There were 47 cases(27.80%)of hypothyroidism,123cases(72.80%)of simple type and 46 cases(27.20%)of nephritis.(5)Pathology:There were 54 cases of percutaneous renal puncture biopsy,including 2 cases(3.70%)in the non-recurrent group and 52 cases(96.30%)in the recurrent group,among which the most common lesions were minor ones(66.67%),followed by mild mesangial proliferative glomerulonephritis(16.67%)and focal segmental glomerulonephritis(11.11%).Membranous nephropathy(3.70%)and membranous proliferative glomerulonephritis(1.85%)were rare.2.Analysis of clinical factors of PNS relapse in children:(1)univariate analysis:The time from initial hormone treatment to urine protein negative conversion was significantly longer in the relapsing group than in the non-relapsing group(the median remission days of the two groups were 13 and 11 days,respectively),and the difference was statistically significant(P<0.05);The serum Ig G(median Ig G of the two groups were 2.96g/L and 3.89g/L,respectively),serum lipoprotein(a)(median serum lipoprotein(a)of the two groups were 636.00mg/L and 426.50mg/L,respectively)and hemuria of the relapsed and non-relapsed groups were statistically significant(P<0.05);(2)Binary logistic regression analysis: Serum Ig G≤3.6(g/L)(0R:3.065,95%CI: 1.520-6.178,P=0.002),serum lipoprotein(a)> 618(mg/L)(0R:4.198,95%CI: 1.999-8.816,P=0.000),urine protein turning negative for more than 12 days(0R:2.999,95%CI: 1.451-6.200,P=0.003)may be the risk factor for recurrence of nephrotic syndrome in children.3.Analysis of the first recurrence inducement: most children have clear inducement before recurrence,and the most common is infection,especially respiratory tract infection(47.62%).4.Prognostic analysis of children’s PNS: By October 2022,the overall complete response rate was 81.66%,and the complete response rate(including clinical cure)of children in the relapsing group and the non-relapsing group were 74.29% and 93.75%,respectively.The difference in prognosis between the two groups was statistically significant(P<0.05).Conclusion1.The incidence of PNS in children is significantly higher in boys than in girls.The peak age of PNS onset is early school age,and it usually occurs in autumn and winter.2.In this study,respiratory tract infection was the most common trigger for the first recurrence of PNS in most children.3.There may be correlation between the time from initial hormone treatment to negative urine protein,hematuria,serum immunoglobulin Ig G and serum lipoprotein(a)at initial treatment and the recurrence of primary nephrotic syndrome in children,in which serum Ig G≤3.6(g/L),serum lipoprotein(a)> 618(mg/L)and urine protein turning negative for more than 12 days may be used as a clinical indicator to predict the recurrence of primary nephrotic syndrome in children.4.The overall complete response rate in this study was 81.66%,and the complete response rate(including clinical cure)in the relapsing group and the non-relapsing group were 74.29% and 93.75%,respectively.The prognosis of the non-relapsing group was better than that of the relapsing group.