IMMUNE FINDINGS IN CHILDREN WITH IDIOPATHIC NEPHROTIC SYNDROME: COULD THEY PREDICT THE RESPONSE TO STEROID THERAPY?
INTRODUCTION: Nephrotic syndrome (NS) is thought to be associated with primary immune disturbances.
OBJECTIVE: The aim of our study was to investigate prospectively the immune disturbances in steroid-sensitive (SS) and steroid-resistant (SR) NS and identify whether these immune disturbances may predict the response to steroid therapy.
METHODS: Thirty children with SS NS and 7 children with SR NS (aged 2 to 14 years) were studied. To evaluate the possible relationship between immune disturbances and response to treatment, patients were evaluated during different disease stages. Data were compared with those obtained from 25 age-matched controls. The following parameters were assessed: basic B- and T-cell populations, percentages of CD23+, CD3+/CD69+/interferon γ+ (IFN-γ+) cells, and CD3+/CD69+/interleukin 4+ (IL-4+) T cells, and serum levels of IL-13 and IL-18.
RESULTS: In patients with SS NS percentages of CD23+ and CD19+ B cells, CD3+/CD69+/IL-4+ T cells and serum levels of IL-13, IL-18 were significantly higher in the active stage compared with the remission stage on steroids, remission off steroids, and controls (P < .05). On the contrary, percentages of CD3+/CD69+/IFN-γ+ T cells were significantly decreased (P < .05). In patients with SR NS, percentages of CD23+B cells, CD3+/CD69+/IL-4+ T cells, and serum levels of IL-13 and IL-18 presented no significant difference between active stage and partial remission. Percentages of CD19+ B cells and CD3+/CD69+/IFN-γ+ T cells were elevated in active stage compared with remission stage of patients with SR NS and in controls (P < .05).
CONCLUSIONS: These findings suggest that when a type-2 immune response is found in the active stage of NS, one could predict a good response to steroid therapy.
Submitted by Nikoleta Printza
- Copyright © 2008 by the American Academy of Pediatrics