Abstract：
We aimed to investigate the renal prognosis of patients with idiopathic nephrotic syndrome (INS) complicated with steroid-induced diabetes mellitus (SIDM), the association of high-density lipoprotein cholesterol (HDL-C) before glucocorticoid treatment with renal prognosis, and the risk for persistent diabetes among patients with INS who had withdrawn from steroid therapy.
We retrospectively analyzed 239 patients with INS complicated with SIDM at the National Clinical Research Center of Kidney Diseases, Jinling Hospital, from January 2008 to December 2019. The primary endpoint was the composite renal outcome defined as the development of end-stage renal disease (ESRD) or a 50% decrease in estimated glomerular filtration rate (eGFR) for more than 24 months after glucocorticoid withdrawal. The secondary endpoint was persistent diabetes, defined as fulfilling the criteria for diagnosing diabetes or using antidiabetic medications for at least 24 months after glucocorticoid withdrawal.
After glucocorticoid withdrawal for over 24 months, 35 (14.6%) patients reached the composite renal endpoint: end-stage renal disease (n = 14) or a 50% decrease in eGFR (n = 21). Before glucocorticoid therapy, a level of HDL-C greater than 1.45 mmol/L worsened renal survival in patients with INS complicated with SIDM. The log10 the level of HDL-C before glucocorticoid treatment was an independent risk factor for the renal outcome. A prediction model was generated: Hazard ratio (renal outcome) = 0.94 * hypertension before glucocorticoid therapy + 2.29 * log10 level of HDL-C before glucocorticoid treatment + 0.90 * the grade of interstitial tubule injury (AUROC, 0.75; 95% CI, 0.63 to 0.87; P < 0.01). Meanwhile, a level of fasting plasma glucose (FPG) before glucocorticoid treatment greater than 5.2 mmol/L enhanced the likelihood of persistent diabetes for at least 24 months after glucocorticoid withdrawal.
Increased level of HDL-C before glucocorticoid therapy was independently associated with a higher risk for renal outcome and thus may be useful in the renal prognosis of patients with INS complicated with SIDM.
We retrospectively analyzed 239 patients with INS complicated with SIDM at the National Clinical Research Center of Kidney Diseases, Jinling Hospital, from January 2008 to December 2019. The primary endpoint was the composite renal outcome defined as the development of end-stage renal disease (ESRD) or a 50% decrease in estimated glomerular filtration rate (eGFR) for more than 24 months after glucocorticoid withdrawal. The secondary endpoint was persistent diabetes, defined as fulfilling the criteria for diagnosing diabetes or using antidiabetic medications for at least 24 months after glucocorticoid withdrawal.
After glucocorticoid withdrawal for over 24 months, 35 (14.6%) patients reached the composite renal endpoint: end-stage renal disease (n = 14) or a 50% decrease in eGFR (n = 21). Before glucocorticoid therapy, a level of HDL-C greater than 1.45 mmol/L worsened renal survival in patients with INS complicated with SIDM. The log10 the level of HDL-C before glucocorticoid treatment was an independent risk factor for the renal outcome. A prediction model was generated: Hazard ratio (renal outcome) = 0.94 * hypertension before glucocorticoid therapy + 2.29 * log10 level of HDL-C before glucocorticoid treatment + 0.90 * the grade of interstitial tubule injury (AUROC, 0.75; 95% CI, 0.63 to 0.87; P < 0.01). Meanwhile, a level of fasting plasma glucose (FPG) before glucocorticoid treatment greater than 5.2 mmol/L enhanced the likelihood of persistent diabetes for at least 24 months after glucocorticoid withdrawal.
Increased level of HDL-C before glucocorticoid therapy was independently associated with a higher risk for renal outcome and thus may be useful in the renal prognosis of patients with INS complicated with SIDM.
摘要：
目的：我们旨在研究特发性肾病综合征（INS）合并类固醇诱导的糖尿病（SIDM）患者的肾脏预后。糖皮质激素治疗前高密度脂蛋白胆固醇（HDL-C）与肾脏预后的关系，以及退出类固醇治疗的INS患者中持续性糖尿病的风险。
方法：我们回顾性分析了在国家肾脏疾病临床研究中心的239例INS合并SIDM患者，金陵医院,从2008年1月到2019年12月。主要终点是复合肾脏结局，定义为终末期肾病（ESRD）的发展或糖皮质激素停药后超过24个月的估计肾小球滤过率（eGFR）下降50％。次要终点是持续性糖尿病，定义为糖皮质激素停药后至少24个月符合诊断糖尿病或使用抗糖尿病药物的标准。
结果：糖皮质激素停药超过24个月后，35（14.6％）患者达到复合肾脏终点：终末期肾病（n=14）或eGFR降低50％（n=21）。糖皮质激素治疗前，HDL-C水平高于1.45mmol/L会降低INS合并SIDM患者的肾脏生存率。糖皮质激素治疗前HDL-C水平的log10是肾脏结局的独立危险因素。生成了预测模型：危险比（肾脏结局）=0.94*糖皮质激素治疗前的高血压+2.29*糖皮质激素治疗前的HDL-Clog10水平+0.90*间质小管损伤的等级（AUROC，0.75；95%CI，0.63~0.87；P<0.01）。同时,糖皮质激素治疗前空腹血糖(FPG)水平超过5.2mmol/L可增加糖皮质激素停药后至少24个月持续糖尿病的可能性.
结论：糖皮质激素治疗前HDL-C水平升高与肾脏结局的高风险独立相关，因此可能对INS合并SIDM患者的肾脏预后有用。
方法：我们回顾性分析了在国家肾脏疾病临床研究中心的239例INS合并SIDM患者，金陵医院,从2008年1月到2019年12月。主要终点是复合肾脏结局，定义为终末期肾病（ESRD）的发展或糖皮质激素停药后超过24个月的估计肾小球滤过率（eGFR）下降50％。次要终点是持续性糖尿病，定义为糖皮质激素停药后至少24个月符合诊断糖尿病或使用抗糖尿病药物的标准。
结果：糖皮质激素停药超过24个月后，35（14.6％）患者达到复合肾脏终点：终末期肾病（n=14）或eGFR降低50％（n=21）。糖皮质激素治疗前，HDL-C水平高于1.45mmol/L会降低INS合并SIDM患者的肾脏生存率。糖皮质激素治疗前HDL-C水平的log10是肾脏结局的独立危险因素。生成了预测模型：危险比（肾脏结局）=0.94*糖皮质激素治疗前的高血压+2.29*糖皮质激素治疗前的HDL-Clog10水平+0.90*间质小管损伤的等级（AUROC，0.75；95%CI，0.63~0.87；P<0.01）。同时,糖皮质激素治疗前空腹血糖(FPG)水平超过5.2mmol/L可增加糖皮质激素停药后至少24个月持续糖尿病的可能性.
结论：糖皮质激素治疗前HDL-C水平升高与肾脏结局的高风险独立相关，因此可能对INS合并SIDM患者的肾脏预后有用。
