关键词: 局灶节段性肾小球硬化, 激素治疗, 尿液miR-30a-5p, 预测作用

Abstract:

ABSTRACT Objective: Previous study showed that there was a close relationship between urinary levels of miR-196a, miR-30a-5p, miR-490 and focal segmental glomerulosclerosis (FSGS). This study aimed to investigate the relationship between urinary miRNAs levels in patients with FSGS and the steroid therapy of FSGS. Methodology: A retrospective cohort analyzed primary FSGS patients treated with steroids. Meanwhile, a prospective cohort analyzed the priamry FSGS patients who were not treated before diagnosis, and then treated with steroids for eight weeks in the study. The urinary levels of miRNAs and proteinuria before treatment, after treatment, and in the middle of the treatment were tested, and the relationship between the levels of miRNAs and proteinuria was investigated. Results: In retrospective cohort, they were 139 patients, 68 patients achieved CR (CR), while 71 of them did not (non-CR). Before treatment, the two groups had no significant difference in gender, age, proteinuria, serum creatinine level and cholesterol level. But the urinary level of miR-30a-5p in the group of non-CR was significantly lower than that in the group of CR (P=0.03). Urinary miR-30a-5p could marginally predict the response to steroid treatment in FSGS patients (AUC 0.63, P=0.03). In prospective cohort, they were 55 patients, 33 patients achieved CR (CR) after treatment, while 22 of them did not (non-CR). The urinary miR-30a-5p level declined as the remission in proteinuria (P<0.001), but in group of non-CR, it did not decrease after steroid therapy. The urinary levels of miRNAs before treatment at fourth and eighth weeks of the treatment were further examined in another 22 patients (11 CR vs. 11 non-CR). The urinary levels of miR-30a-5p decreased during the course of treatment in CR group (P<0.001). Differences in urinary miR-30a-5p levels between patients with and without CR were observed at the 4th week of therapy (P=0.003), prior to changes in proteinuria (P=0.29). Conclusion: The urinary level of miR-30a-5p directly related to the effect of the steroid therapy in patients with FSGS, and could predict the treatment response, and its change was prior to changes in proteinuria. Urinary miR-30a-5p could be used as a new predictive biomarker for prognosis and the treatment response of FSGS.

Key words:  FSGS, steroid therapy, urinary miR-30a-5p, predictive value