Insulin Resistance And Its Relationship With Expression Of ISNR-β, CPR, ENOS In Renal Organism In Primary Nephrotic Syndrome Patients

Objective: To investigate if there is insulin resistance (IR) and its possible pathogenesis in primary nephrotic syndrome patients, if body's insulin sensibitity have any influence on the early therapeutical effect of high-dose glucocorticoid in these patients. Detecting the expression of insulin receptor beta(INSR-β),C-peptide receptor(CPR) and endothelial nitric oxide synthase(eNOS)in the renal organism.Methods: Forty six primary nephrotic syndrome patients and twenty normal controls were included in this test.Of all the patients and normal controls,fasting serum glucose(FG),fasting serum insulin(FISN)and fasting serum C-peptide(FCP) were detected accurately, insulin sensitive index(ISI) were calculated by a formula reported before.Then,the relationship between ISI and blood pressure, blood lipids, blood urea nitrogen,blood creatinine,blood uric acid ,thepatients'pathologic types,the decreasing rate of 24 hours' uric protein(Rup) after two weeks of high-dose glucocorticoid treatment,were investigated.Renal organism of primary nephrotic syndrome patients were obtained by kidney puncture.The control renal organism obtained from the normal part of kidneys of patients who underwent kidney-resecting-operation because of renal tumer or renal injury. The expression of ISNR-β,CPR and eNOS in renal organism were examined by immunohistochemical staining techniques.Results: Compared with normal controls,the concentration of FG,FISN,FCP increased significantly(P<0.01 or P<0.05), and ISI decreased significantly(P<0.01)in primary nephrotic syndrome patients. The ISI of patients correlated negatively with triglyceride(TG) (P<0.05),low density lipoprotein cholesterol(LDL-c)(P<0.05) and blood uric acid(UA)(P<0.01). The patients'ISI has no significant difference among the three pathologic types, and no correlations were found between ISI and Rup after two weeks of high-dose glucocorticoid treatment.The expression of ISNR-β,CPR and eNOS in both renal interstitial and glomerulus has no statistical difference between primary nephrotic syndrome patients and the controls.Compared with renalinterstitial,glomerulus have significantly weaker expression of INSR-β,CPR and eNOS in both groups,and there is no statistical difference between the two groups either. Conclusion Primary nephrotic syndrome patients have rising levels of blood glucose,insulin and C-peptide.Insulin resistance(IR) is presented at the same time.The body's sensibility to insulin has nothing to do with their pathologic types and the early therapeutic effect of glucocorticoid. The expression of ISNR-β,CPR and eNOS has no significant change in both glomerulus and renal interstitial in primary nephrotic syndrome patients.But the expression of ISNR-β,CPR and eNOS in glomerulus was weaker than in renal interstitial.