ABSTRACT
The incidence of immune-mediated inflammatory diseases (IMIDs) is on the rise. A high salt content in the diet was found to play a crucial role in mediating IMIDs. It was demonstrated that increased salt concentration favors the differentiation of CD4+ cells to pathogenic Th17 cells, which predispose to several inflammatory diseases by modulating the immunological milieu. In auto-immune diseases increased salt concentration causes stable induction of Th17 cells. In cancer, increased salt concentration triggers chronic inflammation and increases vascular endothelial growth factor levels. Salt-mediated proliferation of Th17 cells has been found to reduce nitric oxide production in the endothelial cells, leading to hypertension. Increased salt concentration was found to alter the intestinal flora, which favors local inflammation. This review attempts to explain the role of high salt concentration and its molecular pathways in causing IMIDs.
ABSTRACT
Idiopathic nephrotic syndrome (NS) is one of the most common kidney diseases of childhood. In this study, we assessed urine Vitamin-D binding protein (VDBP) and neutrophil gelatinase-associated lipocalin (NGAL) levels as a predictor of steroid responsiveness in idiopathic NS. This cross-sectional study included children with steroid-resistant NS (SRNS) (n = 28), steroid-sensitive NS (SSNS) (n = 28), and healthy controls (n = 28). Urine levels of VDBP and NGAL were measured using a commercially available ELISA kit and normalized to urine creatinine (Cr). Urine microalbumin (MALB) was measured using nephelometer, and MALB/Cr was calculated. Urine Vitamin-D binding protein (uVDBP) and urine neutrophil gelatinase-associated lipocalin (uNGAL) levels were statistically significantly higher (P < 0.001) in patients with SRNS (701.12 ± 371.64 ng/mL and 28.42 ± 15.40 ng/mL, respectively) than in patients with SSNS (252.87 ± 66.34 ng/mL and 8.86 ± 5.54 ng/mL, respectively) and normal controls (34.74 ± 14.10 ng/mL and 6.79 ± 1.32 ng/mL, respectively). Estimated glomerular filtration rate shows a significant negative correlation with MALB/Cr, uVDBP, and uNGAL. However, uVDBP and uNGAL showed a much higher discriminatory ability for differentiating SRNS from MALB/Cr. uVDBP and uNGAL at the cutoff value of 303.81 and 13.1 ng/mL, respectively, yielded the optimal sensitivity (82% and 86%) and specificity (78% and 89%) to distinguish SRNS from SSNS. Urine levels of VDBP and NGAL can predict steroid responsiveness in patients with idiopathic NS.
Subject(s)
Adrenal Cortex Hormones , Lipocalin-2/urine , Nephrotic Syndrome , Vitamin D-Binding Protein/urine , Adolescent , Adrenal Cortex Hormones/pharmacology , Adrenal Cortex Hormones/therapeutic use , Biomarkers/urine , Child , Cross-Sectional Studies , Female , Glomerular Filtration Rate/drug effects , Humans , Male , Nephrotic Syndrome/classification , Nephrotic Syndrome/drug therapy , Nephrotic Syndrome/metabolism , Nephrotic Syndrome/urine , Sensitivity and Specificity , Treatment OutcomeABSTRACT
BACKGROUND: Stress, anxiety and various neurobiological changes have been postulated to be associated with increased suicidal ideation. Hence, this study was undertaken to evaluate the serum concentrations of neurotrophins, inflammatory markers and stress concentrations as predictors of suicidal risk among young adults. METHODS: This cross-sectional study was conducted in a tertiary care referral center in South India from March 2014 to February 2015. We recruited 42 suicide attempters and 42 age- and gender-matched healthy controls. The serum concentrations of neurotrophins (BDNF and NT-3), inflammatory markers (hs-CRP and IL-6) were assessed. Stress severity was assessed by Presumptive Stressful Life Events scale (PSLE) and Daily Hassles and Uplifts Scale-revised (DHUS-R). Psychological distress and Suicide risk was assessed using Hospital Anxiety and Depression Scale (HADS) and Mini International Neuropsychiatric Interview (MINI) respectively. RESULTS: Suicide attempters tend to show significantly lower concentrations of neurotrophins and significantly higher concentrations of inflammatory markers. We observed significant negative correlation of neurotrophins with inflammatory markers, stress, and suicide risk. In multivariate linear regression model, hs-CRP [adjusted ß=0.333, p<0.0001], PSLE [adjusted ß=0.133, p=0.029], DHUS-R [adjusted ß=0.159, p=0.018] emerged as independent predictors of suicide risk (R(2)=0.76). CONCLUSION: Our results suggest that inflammation and stress scores have a moderate association with suicidal ideation.
