Abstract
BackgroundMinimal change disease (MCD) is a form of idiopathic nephrotic syndrome. Compared to children, adult-onset MCD patients are reported to have delayed responses to glucocorticoid treatment. Several studies of children have suggested detecting urinary CD80 levels to diagnose MCD. There are no effective diagnostic methods to distinguish steroid-sensitive MCD from steroid-resistant MCD unless treatments are used.MethodsIn a total of 55 patients with biopsy-proven MCD and 26 patients with biopsy-proven idiopathic membranous nephropathy, CD80 and cytotoxic T-lymphocyte antigen-4 (CTLA-4) levels in serum, urine and renal tissue were analyzed.ResultsSteroid-sensitive MCD patients in remission had lower urinary CD80 levels and higher CTLA-4 levels than patients in relapse (156.65 ± 24.62 vs 1066.40 ± 176.76 ng/g creatinine; p < 0.0001), (728.73 ± 89.93 vs 151.70 ± 27.01 ng/g creatinine; p < 0.0001). For MCD patients in relapse, mean urinary CD80 level was higher, and CTLA-4 level was lower for those who were steroid-sensitive than those who were steroid-resistant (1066.40 ± 176.76 vs. 203.78 ± 30.65 ng/g creatinine; p < 0.0001), but the mean urinary CTLA-4 level was lower (151.70 ± 27.01 vs. 457.83 ± 99.45 ng/g creatinine; p < 0.0001). CD80 expression in glomeruli was a sensitive marker to diagnose MCD. The absent or minimal expression of CTLA-4 in glomeruli could distinguish steroid-sensitive MCD from steroid-resistant MCD.ConclusionsGlucocorticoid treatment may result in complete remission for only MCD patients with strongly positive CD80 expression and negative CTLA-4 expression in glomeruli, or higher urinary CD80 level and lower CTLA-4 level.
Highlights
Minimal change disease (MCD) is a form of idiopathic nephrotic syndrome
The characteristics of patients and pathologic misdiagnosis, which may be due to similar imaging features of MCD, focal segmental glomerulosclerosis (FSGS), and stage I of idiopathic membranous nephropathy (IMN) under light microscopy are possible causes
Comparison of urinary CD80 and cytotoxic T-lymphocyte antigen-4 (CTLA-4) excretion of steroid-sensitive MCD patients in relapse and remission We detected all the laboratory data for all our steroid-sensitive MCD patients when they were in relapse and remission
Summary
Adult-onset MCD patients are reported to have delayed responses to glucocorticoid treatment. Results: Steroid-sensitive MCD patients in remission had lower urinary CD80 levels and higher CTLA-4 levels than patients in relapse (156.65 ± 24.62 vs 1066.40 ± 176.76 ng/g creatinine; p < 0.0001), (728.73 ± 89.93 vs 151.70 ± 27.01 ng/g creatinine; p < 0.0001). Adult-onset MCD patients were reported to have higher risks of acute kidney injury and delayed responses to glucocorticoids treatment (Huang et al, 2001; Szeto et al, 2015). Long-term prognosis may not be favorable, as indicated in a study in which a large number of patients with adult-onset MCD were found to have FSGS on a second kidney biopsy and experienced progression to end-stage renal disease (ESRD) or death (Szeto et al, 2015). Early-stage identification of steroid-resistant nephritic syndrome is needed in MCD patients
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