An 9-year Data Analysis Of Renal Biopsies From A Single Unit And Associativity Of The Reaction Of Primary Glomerular Diseases Patients To Glucocorsteroid Therapy

This study reviews the data which is mainly with respect to primary glomerular diseases in Huashan Hospital during the recent nine years and conducts epidemiologic analysis. The analysis shows that in recent years, primary glomerular diseases still account for the biggest proportion of renal biopsy proven renal diseases; and the ratio of secondary glomerular diseases increases gradually. In Huashan Hospital,the ratio between primary glomerular diseases and secondary glomerular diseases is 1.84 to 1.Among the patients with primary glomerular diseases, the ratio of patients at age of 40-59 and over 60 increases year by year, and the increasing ratio of elder patients is basically consistent with the demographic data of Shanghai.IgA nephropathy accounts for the biggest proportion, which is more than 40%. Among the elder patients, membranous nephropathy is the pathology that accounts for the biggest proportion. In addition, there is a trend that the ratio of membranous nephropathy increases gradually. Conclusion:Primary glomerular diseases account for the biggest proportion of renal biopsy proven renal diseases. The ratio of secondary glomerular diseases increases year by year. IgA nephropathy accounts for the biggest proportion of primary glomerular diseases. The ratio of membranous nephropathy show an increasing tendency. Primary glomerular diseases are the most common diseases in outcomes of renal biopsy. Glucosteroid is widely used clinically as a major treatment method for patients whose proteinuria reach certain quantitation However, not all patients with primary glomerular diseases can have ideal effects. This study divides the patients with primary glomerular diseases who had undertake glucosteroid treatment previously into refractory group and control group based on their reaction to glucosteroid. The retrospective clinical analysis on the glucosteroid effects reveals that total cholesterol,time from the occurrence of symptom to the initial of therapy of the patients that did not have good response to glucosteroid treatment are significantly higher than those of controls,and their seralbumin is significantly lower than that of controls. The low seralbumin and the longer time from the occurrence of symptom to the initial of therapy are the possible independent risk factors to poor reaction of patients with primary glomerular diseases to glucosteroid.The AUC of ROC which is calculated by these two index reaches 0.879. The immunohistochemistry results of GCRs in glomeruli,including three pathology types, MCD,MsPGN and IgAN,indicates that GCR expression of the refractory group is significantly lower than that of the controls. Conclusion:Low rank of seralbumin,longer time from the occurrence of symptom to the initiation of therapy are possibly the independent risk factors to poor reaction of patients with primary glomerular diseases to glucosteroid. Use the regression formula calculated by thses two index may somehow predict the outcome of their reaction to glucosteroid therapy. GCR expression of the refractory group is significantly lower than that of those reacts well.