The Analysis Of Relapse Factors And Outcome In Children With Primary Nephrotic Syndrome

Objective To explore the risk factors affecting the relapse and frequent relapse in children with primary nephrotic syndrome,and to find out indicators that have realistic predictive value for the prognosis of newly diagnosed children,so as to identify high-risk children and guide the clinical practice further.Method The children newly diagnosed as PNS in the General Hospital of Ningxia Medical University from January 2013 to October 2017 were selected as the study subjects.They were divided into non-relapse group and relapse group according to the relapse situation.And clinical data of two groups were compared.The relapse group was divided into non-frequent relapse group(NFR)and frequent relapse group(FR).Then clinical data of them were compared.The count data is measured by χ2 test,and the measurement data is tested by t test or non-parametric test.Cox survival analysis was performed on the statistically significant variables after univariate analysis to explore the risk factors for relapse and frequent relapse of PNS in childre.Results 1.General condition of of 211 children with PNS:(1)The median age of onset was 4.25 years.The peak age of onset was concentrated in preschool.(2)Male to female ratio was 2.91:1.The ratio of han nationality and minority was 1.78:1.Simple type NS to nephritic type ratio was 5.21:1.There was no significant difference in age of onset in terms of gender,nationality and clinical type(P > 0.05).(3)In the onset season,the proportion in spring and summer is high.2.85.87% of the children had a clear cause before recurrence,and the most common cause were respiratory infection(49.77%)and digestive tract infection(8.45%).3.Analysis of risk factors for relapse of PNS in children:(1)There were significant differences in proteinuria elimination time,serum IgM,clinical type,and hematuria between the non-relapse group and the relapse group(p<0.05).(2)Cox survival analysis:Proteinuria elimination time can enter the Cox survival analysis model.The possibility of relapse of children with urinary protein turned over for more than 9 days is high.4.Analysis of risk factors for frequent relapse of PNS in children:(1)There were significant differences in proteinuria elimination time,initial relapse time,clinical type,and hematuria between the NFR group and the FR group(P<0.05).(2)Cox survival analysis:Initial relapse time,proteinuria elimination time can enter the survival analysis model.Here is a high risk of frequent relapse in children with proteinuria elimination time over 12 days and relapse within 7.5 months after initial remission.5.The outcome analysis: As of October 2018,there were 111 children in complete remission(including cured),and the complete remission rate was 82.84%.Conclusion 1.This study found that 85.87% of children with PNS had a clear cause before recurrence.Respiratory tract infections,digestive tract infections are the most common.2.The proteinuria elimination time,clinical type,hematuria,serum IgM at the initial diagnosis and treatment were correlated with the relapse of PNS in children.Children with proteinuria elimination time for more than 9 days are more likely to relapse than those with proteinuria elimination in 9 days.3.The proteinuria elimination time,initial relapse time,clinical type,hematuria were correlated with the frequent relapse of PNS in children.Children with proteinuria elimination time for more than 12 days and who relapse within 7.5 months after the first complete remission are at high risk of frequent relapse.4.The complete remission rate of this group of children was 82.84%.