Interleukin-2 receptor, tumor necrosis factor alpha and immunoglobulins in children with minimal change lesion nephrotic syndrome [MCNS]

ABSTRACT

As minimal change nephrotic syndrome is believed to be an autoimmune disease in which activated T-lymphocytes are concerned with a role for both humoral and cell mediated immunity in the induction of glomerular injury. Study of soluble interleukin-2 receptor and tumor necrosis factor alpha [TNF-] [two important cytokines associated in the regulation of the immune response] and correlation of their levels with serum IgG, IgM, and IgA concentrations as well as indicators of nephrotic syndrome was evaluated in this work. The study was conducted on 30 children with minimal changes nephrotic syndrome [MCNS] [16 on remission state and 14 in relapse state] and 10 healthy children as comparable controls. Those 30 cases of minimal change nephrotic syndrome were chosen from 46 nephrotic cases admitted to pediatric department of Benha University hospital. Diagnosis of MCNS, based on steroid responsiveness and results of renal biopsy as 16 cases were proved to be lesions other than minimal change and were excluded from the study. Significant low levels of IgG and IgA while, significant rise of IgM levels were found in nephrotic patients either in the remission or the relapse state compared to the controls. Also, mean SIL-2R and TNF- levels were significantly increased in the relapse state but were non significantly increased in the remission state in comparison to healthy controls. Moreover, SIL-2R and TNF-levels were negatively correlated to the age of patients, indicators of nephrotic syndrome [blood proteins and serum albumin] and serum concentrations of IgG, IgA and IgM. It was concluded that elevated levels of these cytokines can result in induction of glomerular injury and so they may play a critical role in the pat ho genesis of minimal change nephrotic syndrome. Thus, they can be used as new markers in the diagnosis and to judge prognosis of the disease