ABSTRACT
HLA class II antigens [DR, DQ] were studied in 24 nephrotic children using the microlymphotoxicity method. Twelve patients were steroid sensitive, and the other 12 were steroid resistant Renal biopsy was done in all the steroid resistant cases. HLA-DQ4 antigen was significantly higher among all nephrotic children [33% vs. 8% in controls, X[2c]= 3.97, P<0.05], relative risk was 5.5 [P<0.05] and etiologic fraction was 0.27. In the steroid sensitive group, HLA-DQ2 antigen was 75% vs. 33% in controls [X[2c]= 5.08, P<0.05]. The relative risk was significant and indicates that patients having DQ2 are 6 times more likely to respond to steroid therapy than those without the antigen. In the steroid resistant group, frequencies of HLA-DR9, DR12 and DR14 were increased, pointing to linkage of these antigens and resistance to steroid therapy. HLA-DR12 was 33% in patients vs. 4% in controls, [X[2c] = 4.21, P<0.05]. The relative risk of DR12 was 11.5 indicating that nephrotic patients having DR12 antigen are 11.5 times more liable to be steroid resistant. Our results support the important role of HLA antigens in the pathogenesis of NS, and shed light on the importance of HLA markers as prognostic factors in childhood nephrotic syndrome