To assess the impact of CRP levels on proteinuria, lipid parameters, ECHO parameters and clinical outcome at patients with nephrotic syndrome

OBJECTIVE: Although CRP is not a unique marker of inflammation, it has a diagnostic value in many clinical situations and it has been used as an indicator of activity and clinical outcome in many studies.We aimed to assess the impact of CRP levels on proteinuria, lipid parameters, EKO parameters and clinical outcome at patients with nephrotic syndrome in this study.MATERIALS AND METHODS: The files of patients which hospitalized and treated with diagnosis of nephrotic syndrome (1440 patients) in Nephrology Clinic of Dicle Universty Medical Faculty between years 2000 to 2010 were scanned in this study. The files of 104 patients (49 of them (37.5%) were male, and 55 (62.5%) women) with sufficent data were analyzed retrospectively. Demographic data of the patients, histological diagnosis, blood pressure examination during clinical admission, taken-off the fluid volume, hemoglobin, hematocrit, white blood cell, platelets, glucose, urea, creatinine, sodium, potassium, chloride, calcium, phosphorus, magnesium, uric acid, AST, ALT, LDH, ALP, GGT, cholesterol, triglycerid, HDL, LDL, albumin, total protein, fibrinogen, Ig G, Ig A, Ig M, C3, C4, ESR, CRP, esbach, urine density , urine leukocytes, urine erythrocytes, urine protein, thickness of left atrium, thickness of left ventricular posterior wall, thickness of interventricular septum and values of ejection fraction in EKO and the length of stay at hospital were examined as operating parameters. Patients were divided into two groups according to CRP levels (CRP reference range 0-5 mg / l) . Group 1, CRP level> 5mg / l, Group 2 CRP level ? 5mg / l from the cases. The data obtained were compared between the two groups. Moreover, patients were evaluated by looking at the CRP and other parameters and compared the relationships between them when they were admitted to the clinic and discharged.RESULTS: After grouping according to the CRP values;1 - The average age of patients, was 46.68 ± 20.34 years in the group 1, was 35.92 ± 16.25 years in the group 2 (p = 0.004).2- The 24-hour urine volume which examinated when hospitalization (p = 0.003) and levels of calcium (p = 0.001), albumin (p = 0.001), total protein (p = 0.035), HDL (p = 0.038) and hemoglobin (p = 0.032) were significantly lower in group 1 according to group 2.3 - There were high levels of statistical significance between age (p = 0.004), length of stay at the clinic (p = 0.030), creatinine (p = 0.009), LDH (0.006), platelet (0.005), ESR (p <0.001) , C4 (p <0.001), urinary protein (p = 0.038) and esbach (p <0.001) in group 1 according to group 2 . Although LDL(p = 0.051) was higher levels in group 1 according to group 2 but there was not statistically significant.4 -There were not significant correlation between CRP levels and cardiac parameters measured with EKO (LAD, EA, SVPDK, EF)(p> 0.005).5-We detected a positive correlation between CRP elevation and levels of urea (p = 0.015), creatinine (p = 0.003), LDH (p = 0.015), WBC (p = 0.004), ESR (p = 0.004), C4 (p = 0.023), urine leukocyte (p = 0.032), urine red blood cells (p = 0.041), 24-hour urine protein (p = 0.044) levels and negative correlation between CRP elevation and amount of 24-hour urine (p = 0.043) with correlation of CRP and other parameters.CONCLUSION: The increase in the amount of proteinuria, worsening renal function, prolonged hospitalization, decrease in the value of serum albumin and daily urine volume between patients with nephrotic syndrome was higher in the group with high CRP values according to the group with normal CRP values.We found a positive correlation between CRP and urea, creatinine, leukocytes, sedimentation rate, complement and esbach, a hnegative correlation between albumin and the amount of daily urine.Large-scale studies are needed to examine the relationship between CRP and proteinuria, disease activity, lipid parameters, echocardiographic parameters and clinical course in nephrotic syndrome in adult patients.