Steroid-resistant Patients Research Articles

Serum Antibody Response to Pneumococcal Vaccine in Children with Nephrotic Syndrome

Children with nephrotic syndrome are susceptible to serious pneumococcal disease and may be immunodeficient on the basis of abnormal humoral immune responses to natural antigens or immunoglobulin loss during relapse. As part of an ongoing study to evaluate pneumococcal anticapsular antibody concentration and immunologic competence, 27 steroid-responsive and six steroid-resistant patients with nephrotic syndrome, and 12 age-matched control subjects, were vaccinated with polyvalent pneumococcal vaccine. Antibody responders were defined as patients with at least a twofold increase in antibody after vaccination as well as an antibody concentration greater than 200 ng of anticapsular antibody nitrogen per milliliter (ngN/ml) after vaccination. Pneumococcal antibody concentrations before and after vaccination were significantly depressed in steroid-resistant patients when compared with control subjects (P less than .002) and with the steroid-responsive nephrotic syndrome group (P less then .001). Steroid-responsive nephrotic children who were not receiving corticosteroid therapy at the time of vaccination had significantly higher antibody concentrations to five pneumococcal types before vaccination and to seven types after vaccination compared with control subjects (P less than .05). Fewer steroid-responsive patients receiving corticosteroids achieved antibody concentrations greater than or equal to 200 ngN/ml against type 19F compared with patients not receiving steroids or with control subjects (P less than .05). These results suggest that pneumococcal vaccine is immunogenic in children with steroid-responsive nephrotic syndrome and may protect these patients from disease due to pneumococcal types contained in the vaccine.

Prediction of the histological type of glomerulonephritis. Multiple discriminant analysis of clinical and laboratory characteristics at time of diagnosis.

We performed a prospective study on 68 subjects with biopsy-proven clomerulonephritis using a discriminant analysis of 12 clinical and laboratory characteristics. Among these, the selectivity of proteinuria, the presence of hematuria and the plasma level of C3 proved to be the most useful. An equation based on these three variables discriminated without overlap between 17 patients with minimal change glomerulonephritis (MCGN) and 30 patients with either membranoproliferative or rapidly progressive glomerulonephritis. However, some overlap existed between MCGN and focal sclerosis or membranous glomerulonephritis. In addition, the formula seems to identify steroid-resistant patients with MCGN.

Assessment of Serum Factor B, Serum Opsonins, Granulocyte Chemotaxis, and Infection in Nephrotic Syndrome of Children

Chemotactic and opsonic functions and concentrations of factor B were investigated in serum from 18 steroid-sensitive and four steroid-resistant pediatric patients with nephrotic syndrome during various clinical states. Placement of sera from nephrotic children in relapse in the stimulant compartment of Boyden chambers resulted in chemotaxis scores that were significantly lower (P < 0.001) than scores for remission or control sera. Scores observed for zymosan-activated sera of relapsing nephrotic patients were also diminished compared with scores for sera from the same patients during remission or scores for sera from adult controls. In a modified chemiluminescence assay, opsonic activity for zymosan in relapse sera was diminished significantly (P < 0.05, P < 0.01) compared with that in remission and control sera respectively. Chemiluminescent values increased in all cases in remission sera compared with those in the respective relapse sera. As demonstrated by indirect immunofluorescence, C3 zymosan deposition in relapse sera was generally decreased compared with that in the respective remission sera or in control sera. Concentrations of factor B (mean ±SE, in mg/dl) in relapse sera (9.13 ± 1.0) were significantly lower (P < 0.001) than concentrations in remission sera (22.1 ± 1.3) or in adult (control) sera (23.1 ± 1.4). Systemic bacterial infection of nephrotic patients in relapse states was related to decreased values for serum chemotaxis, chemiluminescence, and immunofluorescence and diminished concentrations of factor B in serum.