Abstract. Background. Nephrotic syndrome (NS) characterized by a large amounts of protein into urine and a set of indications that include: protein in urine, low ...
http:// ijp.mums.ac.ir Original Article (Pages: 3489-3497)
The Relationship between Blood Biomarkers Level and the Prognosis of Nephrotic Syndrome in the Children Parsa Yousefichaijan1, *Masoud RezagholiZamnjany2, Fatemeh Rafiei3, Hassan Taherahmadi1, Aziz Eghbali1, Mohammad Rafiei3, Sima Tayebi21 1
Associate Professor of Pediatric Nephrology, Department of Pediatric Nephrology, Amir Kabir Hospital, Arak, Iran. 2Medical Student, School of Medicine, Arak University of Medical Sciences, Arak, Iran. 3 Biostatistician, Departman of Biostatistics, Arak University of Medical Sciences, Arak, Iran.
Abstract Background Nephrotic syndrome (NS) characterized by a large amounts of protein into urine and a set of indications that include: protein in urine, low blood protein levels, high cholesterol levels, high triglyceride levels, and swelling. Therefore, aim of this study was to investigate the relationship between prognosis of nephrotic syndrome and blood biomarkers level in children of Arak city, Iran. Materials and Methods This was a prospective study of case series patients which conducted on 100 children with nephrotic syndrome referred to the pediatric clinic in Arak-Iran durring 2015 to 2016, to determine the resistance to steroids initially. All children had been taking Prednisolone and then, they were divided into four groups based on response to steroid. Also, blood biomarkers obtained from interviewing. Data were analyzed using SPSS-21. Results Results showed that children with steroids responded nephrotic syndrome rather than frequent relapse nephrotic syndrome, steroid resistance nephrotic syndrome and steroids dependent nephrotic syndrome patients had lower blood inflammatory and higher blood anti-inflammatory markers and there was a significant difference between these markers (P2.0. The patients were selected on the basis of this criteria that inclusion criteria were: Age < 18 year, absence of another congenital kidney disease, consent to participate in research projects and exclusion criteria were: severe liver,
Int J Pediatr, Vol.4, N.9, Serial No.33, Sep 2016
kidney or cardiac disease, by any reason patient leave the study and not satisfied to use their personal data in the study. 2-1. Measurements All tests conducted and assessed for all participants for detection of blood markers level. On admission to the hospital blood sampling was done from children in a sitting position and by unit nurses. Blood biomarkers of patients were obtained by serum analysis. About different levels of blood markers, which was determined by serum analysis, and diagnostic standard patients divided into three categories: normal, higher than normal and lower than normal based on the values which provided for these biomarkers. About response to steroid children were divided into 4 groups, based on their responses to treatment with corticosteroids, responding to steroids, frequent relapse, steroid resistance and steroid dependent. Upon the completion of project blood factors who were examined in patient (Cho, C-reactive protein (CRP), Na, hemoglobin, white blood cell count, Red blood cell count, hematocrit, mean corpuscular volume, mean corpuscular hemoglobin, mean corpuscular hemoglobin concentration, Red blood cell distribution width, platelet count, mean platelet volume, platelet distribution width, procalcitonin, neutrophil, lymph, monocyte, and eosinophil, basophile) were compared together in four groups. 2-2. Ethics Ethical issues (including plagiarism, data fabrication, double publication) have been completely observed by the authors. Also, the study protocol was approved by the ethical committee of Arak University of Medical Sciences. 2-3. Statistical analysis Sample size was determined according to previous studies(1, 3, 6) and taking into account the standard deviation equal to 11
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Blood Biomarkers and Prognosis of Nephrotic Syndrome
standard deviation (SD), 95% confidence level (CI) and 90% power assuming and by using PASS NCSS software 90 was calculated for minimum sample size. Also, by taking into account the loss of about 10% of samples, we included 100 children with nephrotic syndrome diagnosis in patient group. On the other hand, data analysis was conducted by fisher exact, ANOVA and Chi-square test, using SPSS version 21 software and significance level considered for significant difference in groups (P0.05) for this blood biomarkers (Table- 2).
Table-1: Demographic characteristics of children with Nephrotic Syndrome
Male
Steroid responded (remission) (n=25) 42
Female
67
22
48
4.90 ± 2.17
4.79 ± 6.07
4.90 ± 0.64
76
68
40
Variables
Gender
Mean ± SD With a Private Residence Home Status Without a Private Home SD: Standard deviation. Age
Steroids dependent (n=25)
Steroid resistance (n=25)
Frequent relapse (n=25)
Total (n=100)
67
54
52
68
48
65
1.01 ± 0.72 3
3.14 ± 6.87
P- value
0.004 0.001
73 0.02
24
32
60
64
60
Table-2: Details of blood biomarkers percentage in children with Nephrotic Syndrome Variables
WBC (%)
Cho (%)
CRP (%) Hgb (%)
RBC (%)
Hct (%)
MCV (%)
MCH (%)
Steroid responded (remission) (n=25) 96 0
Steroids dependent (n=25)
Steroid resistance (n=25)
Frequent relapse (n=25)
Total (n=100)
72 24
56 44
52 40
70 27
4
4
0
8
4
72
32
12
8
31
28 0 0
40 20 8
12 32 44
16 32 44
24 21 24
16
60
56
64
49
Negative Normal Higher Lower Normal Higher Lower Normal
84 96 4 0 96 0 4 92
40 80 0 20 76 8 16 76
44 84 4 12 84 0 16 84
36 64 12 24 68 4 28 68
51 81 5 14 81 3 16 80
Higher Lower Normal higher Lower Normal
4 4 88 8 4 92
0 24 76 24 0 72
0 16 84 16 0 84
0 32 68 32 0 68
1 19 79 20 1 80
Higher Lower
0 8
4 24
0 16
0 32
2 18
Normal Higher Lower 250-350 and Lower 350-450 450-550 550 and Higher Positive
Int J Pediatr, Vol.4, N.9, Serial No.33, Sep 2016
P- value
0.001
0.001
0.002 0.032
0.109
0.06
0.202
0.126
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Blood Biomarkers and Prognosis of Nephrotic Syndrome Normal Higher
92 0
76 0
84 0
68 4
80 2
Lower Normal
8 92
24 76
16 80
28 68
18 79
Higher
0
16
16
12
11
Lower Normal
8 92
8 40
4 20
20 20
10 43
Plt
Higher Lower Normal
8 0 92
56 4 44
80 0 16
76 4 28
55 2 45
0.001
MPV
Higher
0
0
4
0
1%
0.001
Lower Normal
8 100
56 100
80 100
72 96
54 99
Higher
0
0
0
4
1
Lower Normal
0 92
0 84
0 56
0 52
0 71
Neutrophil
Higher Lower Normal
8 0 92
16 0 84
40 4 52
44 4 56
27 2 71
0.005
Lymphocyte
Higher
0
0
8
0
2
0.003
Lower Normal
8 100
16 100
40 96
44 100
27 99
Higher
0
0
0
0
0
Lower Normal
0 100
0 100
4 100
0 100
1 100
Eosinophil
Higher Lower Normal
0 0 100
0 0 100
0 0 100
0 0 100
0 0 100
>0.05
Basophile
Higher Lower
0 0
0 0
0 0
0 0
0 0
>0.05
MCHC
RDW
Pct
Monocyte
0.227
0.172
>0.05
>0.05
4- DISCUSSION This study aimed to consider the relationship between nephrotic syndrome and blood biomarkers in the children. Kidney of healthy children has a low urinary protein excretion (
