Abstract
BackgroundFew studies have addressed the effects of human leukocyte antigen (HLA) alleles on different clinical sub-phenotypes in childhood steroid-sensitive nephrotic syndrome (SSNS), including SSNS without recurrence (SSNSWR) and steroid-dependent nephrotic syndrome/frequently relapse nephrotic syndrome (SDNS/FRNS). In this study, we investigated the relationship between HLA system and children with SSNSWR and SDNS/FRNS and clarified the value of HLA allele detection for precise typing of childhood SSNS.MethodsA total of 241 Chinese Han individuals with SSNS were genotyped using GenCap-WES Capture Kit, and four-digit resolution HLA alleles were imputed from available Genome Wide Association data. The distribution and carrying frequency of HLA alleles in SSNSWR and SDNS/FRNS were investigated. Additionally, logistic regression and mediating effects were used to examine the relationship between risk factors for disease process and HLA system.ResultsCompared with SSNSWR, significantly decreased serum levels of complement 3 (C3) and complement 4 (C4) at onset were detected in SDNS/FRNS (C3, P < 0.001; C4, P = 0.018). The average time to remission after sufficient initial steroid treatment in SDNS/FRNS was significantly longer than that in SSNSWR (P = 0.0001). Low level of C4 was further identified as an independent risk factor for SDNS/FRNS (P = 0.008, odds ratio = 0.174, 95% confidence interval 0.048–0.630). The HLA-A*11:01 allele was independently associated with SSNSWR and SDNS/FRNS (P = 0.0012 and P = 0.0006, respectively). No significant HLA alleles were detected between SSNSWR and SDNS/FRNS. In addition, a mediating effect among HLA-I alleles (HLA-B*15:11, HLA-B*44:03 and HLA-C*07:06), C4 level and SDNS/FRNS was identified.ConclusionsHLA-I alleles provide novel genetic markers for SSNSWR and SDNS/FRNS. HLA-I antigens may be involved in steroid dependent or frequent relapse in children with SSNS as mediators of immunoregulation.
Highlights
Idiopathic renal syndrome (INS) is the most common cause of chronic glomerular disease in children
After correcting for sex, age at onset and other confounding factors, this study suggested that the significant decreased complement 4 (C4) level in children with SDNS/FRNS, which indicate that it may be an independent risk factor for these patients (P = 0.008, OR = 0.174, 95% CI 0.048–0.630)
Since human leukocyte antigen (HLA)-DR7 was first reported as the risk locus of sensitive nephrotic syndrome (SSNS) in the 1980s, the correlation between HLA-DQA1, DQB1, DR/DQ, DRB1 and SSNS have been found and verified, indicating that HLA alleles play an important role in the occurrence and development of SSNS (Supplementary Tables 3, 4)
Summary
Idiopathic renal syndrome (INS) is the most common cause of chronic glomerular disease in children. Approximately 50% of children with initial SSNS exhibit decreased hormone sensitivity and increased likelihood of relapse during infection, steroid tapering or soon after discontinuation. These patients require second-line steroid-sparing therapy and can progress to a frequently relapse (i.e., frequently relapse nephrotic syndrome, FRNS) or steroid-dependent course (i.e., steroid-dependent nephrotic syndrome, SDNS) [5, 6]. Few studies have addressed the effects of human leukocyte antigen (HLA) alleles on different clinical subphenotypes in childhood steroid-sensitive nephrotic syndrome (SSNS), including SSNS without recurrence (SSNSWR) and steroid-dependent nephrotic syndrome/frequently relapse nephrotic syndrome (SDNS/FRNS). HLA-I antigens may be involved in steroid dependent or frequent relapse in children with SSNS as mediators of immunoregulation
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