Multiple Factors Analysis Of Sreroid Resistance Of Minimal Change Nephrotic Syndrome

Purpose:To establish a clinical procedure for steroid-resistant minimal change nephrotic syndrome by evaluating risk factors of this disease,is helpful to early diagnosis,improve the curative effect and evaluating prognosis,delay the development of renal failure.Methods:68 patients,who were admitted to The First Affiliated Hospital of Guangxi Medical University and were confirmed as minimal change nephrotic syndrome by renal biopsies during Jan 1st 2012 and Apr 30th 2013,were retrospectively analyzed,and divided as steroid-resistant group and non steroid-resistant group,after analyzing their clinical data(gender,age,infectious condition el),laboratory tests results(such as red blood cell count,urine protein,urine occult blood,coagulation,24h urinary protein,Ucr,uric acid,serum calcium,serum phosphorus,urinary cylinder,GFR,cystatin C,immune globulin,ESR,high-sensitive CRP,thyroid function,blood lipid,serum albumin,complement,el)and follow-up visits.A univariate analysis was performed firstly.Then the significant ones were performed a multivariate analysis using binary Logistic regression model.Lastly,the sensitivity,the specificity,and the best threshold value of the indexes,which as indicating the steroid-resistant minimal change disease,was testified by drawing a receiver operating characteristic curve(ROC).Results:(1)68 patients were confirmed as minimal change nephrotic syndrome,while 30 were steroid-resistant,38 were non steroid-resistant.(2)The univariate analysis testified that a combined infection(P=0.014),red blood cell count(P=0.005).total cholesterol(P=0.015),24h urinary protein(P=0.000),serum albumin(P=0.011),high urine uric acid(P=0.045),C4 decrease(P=0.028)were all the risk factors of steroid-resistant minimal change disease(P<0.05).(3)And the multivariate analysis with binary Logistic regression model showed that infection(OR 4.265,95%IC=1.033?17.609 P=0.045),red blood cell count(OR 2.468,95%IC= 1.124?5.420 P=0.024),24h urinary protein(OR=1.001,95%IC=1.000-1.002,P=0.039),were independent risk factors of steroid-resistant minimal change disease.(4)Red blood cell count in urine>3.5/HP,24h urinary protein>5.57g/d total cholesterol>9.49mmol/L,which were significant single factor and were analyzed by ROC,were the best threshold value indicating steroid-resistant minimal change disease.Conclusion:(1)infection,hematuria,24h urinary protein quantitative is independent risk factors of Steroid-resistant minimal change nephrotic syndrome.(2)when Occur hematuria,24h urinary proteind>5.57g/d,total cholesterol?9.49mmol/L,should be alert to the occurrence of Steroid-resistant minimal change nephrotic syndrome.