Expression And Clinical Significance Of Serum Soluble Uroknase Plasminogen Activator Receptor In Adult Primary Nephrotic Syndrome Patients Serum

Objective: Membranous nephropathy(MN), focal segmental glomer ulosclerosis(FSGS) and minimal change disease(MCD) are the three common pathological types that cause of primary nephrotic syndrome(PN S) in adults among our country. The three diseases are similar in presen tation,with different degrees of podocytes damage and clinical present of nephritic syndrome.As such, it is not usually possible to distinguish between them using clinical or biochemical criteria and, in order to obtain an accurate diagnosis, it is necessary to perform a renal biopsy.Circulat ing factors of pathogenic hypothesis has been for many years,until 2011,Wei and colleagues discovered that in two thirds of patients with FSGS soluble urokinase plasminogen activator receptor has high expression, so with that it is regarded as the circulating pathogenic factors of FSGS,and espected to become the serum markers in the diagnosis of FSGS.But it had been questioned by scholars from Beijing,Japan and India.As research continues,researchers gradually found that su PAR appeared to be pr ominent candidate for forecasting the patients' steroid response,and the value in disease activity and therapeutic efficacy.The study aims to underst and the suPAR level in MCD,FSGS and MN,the three critical types in primary nephrotic syndrome,and the diagnosetic value.To explore the rela tionship between patients outcome and the change of suPAR level after receive treatment, and the significance in judging the clinical treatment efficacy.Methods:We collected 60 patients who first time came to the department of nephrology at the second hospital of Hebei University School of Medicine,from December 2014 to November 2015 with primary nephrotic syndrome(PNS).In the 60 patients with renal biopsy diagnosis of MCD 20 patients(male 11 cases,female 9 cases),18 patients with FSGS(male 10 cases,female8 cases),22 patients with MN(male 12 cases,female10 cases).The exclusion criteria included the patients who with the following disease: 1)Secondary nephritic syndrome(diabetic nephropathy,lupus nephritis,hepatitis B virus associated gomerulonephritis,hypertensive kidney lesion,obesity-related glomerulopathy)and genetic family history of kindey disease; 2)tumor,sepsis,stherosclerosis,liver disease,lung cancer and other autoimmune diseases; 3)Infection and using antibiotics nearly one m onth; 4)mental illness or nocooperators.1 According to the pathological types were divided into MCD group,FSGS group,MNgroup; 2 All patients were followed up for 2 months(Since the application of prednisone or immunosuppressants),according to the recovery after 2 months treatment can be divided into complete remission group,partial remission group,no remission group.20 cases of normal control group(male 10 cases,female 10 cases). Serum suPAR was detectedby ELISA,and collected patients' gender,age,and clinical indicators such as 24 hours urinary protein quanti tative,hemoglobin,serum albumin,crestinine,blood lipid, triglycerides,creactive protein.The receiver-operating characteristic curve(ROC) analysis suPAR differential diagnosis accuracy andspecificity of FSGS. Using Wilcox on singed rank test analysis suPAR andvarious clinical indicators changes before and after therapy.Results: 1 The clinical data:health group compared with PNS group there have no significant difference in clinical indexes,such as,age,gender and C-reactive protein(P>0.05). The hemoglobin,total cholesterol,triglyce rides,creatinine and 24 hours urinary protein quantitative were higher in PNS group than the control group,and the serum albumin and eGFR were lower in PNS group than the control group, the difference was statistically significant(P<0.05). According to the pathological type divided into three groups, among the three groups no significant differences were observed in age,gender,hemoglobin, creatinine and C-reactive protein(P>0.05). Age and serum albumin were significantly higher in FSGS and MN group than MCD group, The 24 hours urinary protein quantitative,the difference was significantly higher in MCD group than FSGS and MN group(P<0.05);The patients with FSGS displayed significantly lower 24 hours urinary protein quantitative than MN group(P<0.05); 2 The correlation of suPAR with clinical indicators in PNS: the correlation ana lysis showed that the serum suPAR of PNS patients was positively correlated with age(r=0.42,P<0.05),creatinine(r=0.51,P<0.05), and negatively correlated with eGFR(r=-0.42,P<0.05), there was no correlation with 24 hours urinary protein quantitative,serum albumin,blood lipid,c-reactive protein and so on;3 The correlation of suPAR with pathological types:Comp ared with different pathological types groups found that the serum suPAR level in three kidney disease groups were higher than control group[r espectively(2279±781)pg/ml?(3378±868)pg/ml?(2458±796)pg/ml?(1389±751),P<0.05].Moreover,compared with MCD and MN in serum su PAR the difference had no statistical difference(P>0.05).A suPAR value >3217pg/mlasa cutoff point had a sensitivity of 78% and a specificity of 77%, with an area under the curve(AUC) of 0.780[(95%C1(0.678~0.745)], for identifying patients with FSGS.While in MCD and MN group there was no statistically significant(P>0.05),that prompt little diagnosis value;4 On the basis of the recovery of patients after treatment for 2 months is divided into complete remission group(15 cases),partial remissi on group(22 cases), no remission group(23 cases). The suPAR, 24 hours urinary protein quantitative,TC were significantly lower and serum albumin was higher compared with before treatment in complete remission. The hemoglobin, creatinine, C-reactive protein,and triglycerides were no statistically significant(P>0.05).And no remission group was no statisti cally difference;5 The change of suPAR: the suPAR level obviously decl ine in complete remission group, the difference was statistically significant(P<0.05); the partial remission group was on the decline, However, in no remission group there was no obviously change in suPAR level.The correlation analysis found that the ?suPAR waspositively correlated with thechange of 24 hours urinary protein(?24Upro)(r=0.68,P<0.05),and negatively correlated with ?ALB(r=-0.52,P<0.05), ?TC(r=-0.34,P<0.05).Conclusions: 1 The serum suPAR is associated with the onset of patients with PNS, the Serum suPAR level>3217 pg/mL have larger significance in the diagnosis of FSGS, expected to be a biochemical indicator to identified FSGS. 2 Serum suPAR levels was associated with the patients' clinical treatment effect,and the decline of suPAR was indicated the illness turn for the better,expected to be a clinical indicators to observed the treatment curative effect of patients.