ABSTRACT
BACKGROUND/AIMS: Interleukin (IL)-18, a member of the IL-1 cytokine superfamily, is recognized as an important regulator of immune responses. The aim of our study was to investigate the IL-18 levels in serum and urine from children with idiopathic nephrotic syndrome (INS) during relapse and remission, and to evaluate the role of IL-18 in this disease. METHODS: 67 children with INS, aged 3-16 years, and 15 normal controls were included in the study. The patients were divided into two groups according to activity of the disease: I (n = 37) - INS in relapse, II (n = 30) - INS in remission. Serum and urinary IL-18 were determined by ELISA and in urine related to the urinary creatinine (Cr) concentration. Serum creatinine, protein, albumin and 24-hour proteinuria were measured in children with INS. RESULTS: Urinary IL-18 concentration was significantly higher in group I (213.51 +/- 162.15 pg/mg Cr) compared to group II (64.74 +/- 10.95 pg/mg Cr) and to normal controls (37.03 +/- 4.1 pg/mg Cr, p < 0.001). Serum IL-18 concentration was significantly higher in group I than in the controls (146.4 +/- 30.2 and 113 +/- 10 pg/ml, respectively; p < 0.05); the differences between either groups I and II or group II and controls were not significant. Urinary IL-18 correlated positively with serum IL-18 and with urinary protein excretion, but no correlations were found with other laboratory data. CONCLUSION: Increased serum and urine IL-18 levels were observed during relapse of INS. These findings indicate the association between the active phase of INS and the levels of IL-18 and can suggest the role of this cytokine in the INS development. The changes in urinary IL-18 excretion in the course of INS are connected with the disease activity.
Subject(s)
Interleukin-18/blood , Interleukin-18/urine , Nephrotic Syndrome/immunology , Adolescent , Case-Control Studies , Child , Child, Preschool , Female , Humans , Male , Nephrotic Syndrome/blood , Nephrotic Syndrome/urine , Recurrence , Remission InductionABSTRACT
A 11-years old cyclosporin-treated girl with nephrotic syndrome, complicated by severe toxic diarrhoea with excessive metabolic alkalosis and dyselektrolitemia (hyponatremia, hypokaliemia, hypochloremia) and transient immunoglobulin deficiency is reported. Ultrasonography shows thickeness of the colonic wall as a symptom of colonic inflammation. After discontinuation of cyclosporin therapy, excluding infectious origin of diarrhoea (bacterial, viral and fungal infection), partial parenteral nutrition, enteral nutrition (Peptisorb), probiotics and antidiarrhoeal drugs were used in the treatment. After introducing steroids orally (Entocort) complete resolution of symptoms were observed.
Subject(s)
Colitis/chemically induced , Cyclosporine/adverse effects , Diarrhea/chemically induced , Immunosuppressive Agents/adverse effects , Nephrotic Syndrome/drug therapy , Child , Colitis/diagnostic imaging , Female , Humans , UltrasonographyABSTRACT
UNLABELLED: T-cells and their cytokines play an important role in the pathogenesis of idiopathic nephrotic syndrome (INS) in children. IL-17 secreted by activated CD4+ Tcells induces production of proinflammatory mediators, enhances T-cell-mediated immune responses and Th1 type reactions. The aim of the study was to evaluate IL-17 concentrations in serum and urine of children with INS and determine the possible role of this cytokine in the course of disease. PATIENTS AND METHODS: 67 children with INS, aged 3 to 16 years (mean 9 +/- 4) and 15 normal controls were included in the study. The patients were divided into 2 groups according to activity of the disease: I (n=37)--INS in relapse, II (n=30)--INS in remission. Serum (s) and urinary (u) IL-17 were determined by immunoenzymatic method. In children with INS serum biochemical parameters, clearance of endogene creatinine and 24 hour proteinuria were measured. RESULTS: sIL-17 and uIL-17 concentrations (51.66 +/- 8.38 pg/mg and 56.29 +/-14.24 pg/mg creatinine (cr), respectively) were significantly higher (p<0.001) in group I compared with group II (35.7 +/- 10.18 pg/ml and 17.47 +/- 3.46 pg/mg cr) and normal controls (27.17 +/- 1.87 pg/ml and 13.91 +/- 1.22 pg/mg cr). UIL-17 correlated positively with sIL-17 (r=0.783, p<0.0001). A positive correlations between uIL-17 and sIL-17 and urinary protein excretion were found (r=0.58, r=0.42, respectively; p<0.05). IN CONCLUSION: elevated serum and urinary IL-17 levels in children with relapse of nephrotic syndrome suggest the role of IL-17 in the pathophysiology of INS. IL-17 concentrations in serum and urine may reflect the disease activity of INS.