Yonsei Med J.  2012 Jul;53(4):715-722. 10.3349/ymj.2012.53.4.715.

The Clinical Characteristics of Steroid Responsive Nephrotic Syndrome of Children according to the Serum Immunoglobulin E Levels and Cytokines

• Youn YS
• Lim HH
• Lee JH

• KMID: 1716868
• DOI: http://doi.org/10.3349/ymj.2012.53.4.715

Abstract

PURPOSE
The nephrotic syndrome (NS) is characterized by the favorable response to glucocorticoid therapy and the development of NS may be associated with dysfunctional immune systems. In order to investigate the serum immunoglobulin E (IgE) levels and cytokines activity in pediatric NS, the total of 32 steroid responsive NS patients and 5 healthy controls were enrolled in this study.
MATERIALS AND METHODS
All patients were divided into two groups according to the initial serum IgE levels, such as normal and high IgE group, and their clinical characteristics were evaluated. In addition, serum levels of interleukin (IL)-4, IL-5, IL-10 and transforming growth factor (TGF)-beta were compared and correlated with serum albumin, proteinuria by means of disease severity, and cytokines.
RESULTS
In the high IgE group, the higher comorbidity of allergic diseases and relapsing rate, the longer duration of steroid therapy before initial remission, and the higher serum IL-4 and IL-5 levels were found. In all patients, initially higher serum levels of IL-4 and IL-5 declined to normal levels after steroid therapy, whereas the serum IL-10 levels showed no significant difference between nephrotic phase (heavy proteinuria) and remission phase (no proteinuria) of NS. The serum TGF-beta levels of the nephrotic phase were significantly lower than those of remission phase or control group, and returned to normal control levels after steroid therapy.
CONCLUSION
This study indicates that initial IgE level is associated with steroid responsiveness and disease severity, and cytokine activities may also be related to the pathogenesis of pediatric steroid responsive NS.

Keyword

Idiopathic nephrotic syndrome; IgE; TGF-beta; cytokines

MeSH Terms

Adolescent
Child
Child, Preschool
Cytokines/*blood
Female
Humans
Immunoglobulin A/blood
Immunoglobulin E/*blood
Immunoglobulin G/blood
Immunoglobulin M/blood
Infant
Interleukin-4/blood
Interleukin-5/blood
Male
Nephrotic Syndrome/*blood/*drug therapy
Steroids/*therapeutic use
Transforming Growth Factor beta/blood

Figure

• 

  Fig. 1 Comparisons of the serum IL-4 and IL-5 levels according to the serum IgE levels. Initial serum IL-4 and IL-5 levels were significantly higher in the high IgE group than in the normal IgE group. IgE, immunoglobulin E; IL, interleukin.

• 

  Fig. 2 Comparison of serum IgE levels according to the remission state. There were no changes in the median (range) levels of serum IgE according to the treatment state (nephrotic or remission phase) between the normal (p=0.667) and high IgE groups (p=0.131). IgE, immunoglobulin.

• 

  Fig. 3 Comparisons of the cytokines between nephrotic syndrome patients and healthy controls. (A) The serum levels of IL-4 in nephrotic syndrome patients with nephrotic phase were significantly higher than those of remission phase and controls. (B) The serum levels of IL-5 in nephrotic phase were also higher than those of normal controls. (C) The serum IL-10 levels did not show any significant differences in each group. (D) In the patients with nephrotic phase, the serum levels of TGF-β were significantly lower than those of remission phase or control group. This were calculated by using Kruskal-Wallis test Scheffe's post hoc comparison. The **means p<0.001, and *indicates p<0.05. IL, interleukin; TGF, transforming growth factor; NS, nephrotic syndrome.

• 

  Fig. 4 Correlations between serum cytokines and albumin levels. By linear regression analysis, (A) the serum IL-4 levels had a negative correlation with serum albumin (p=0.004), (B) the serum IL-5 levels had no correlation with serum albumin (p=0.113), (C) the serum IL-10 levels did not have a positive correlation with serum albumin levels (p=0.571), whereas (D) the serum TGF-β levels had (p<0.001). IL, interleukin; TGF, transforming growth factor.

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