The long-term outlook to final outcome and steroid treatment results in children with idiopathic nephrotic syndrome

Retrospective Cohort Analysis of Class II Human Leukocyte Antigen (HLA) Alleles in Children With Steroid-Dependent Nephrotic Syndrome Treated With Cyclophosphamide

Background The role of specific human leukocyte antigen (HLA) alleles as a risk factor for susceptibility, protection, and response to cyclophosphamide (CYC) treatment has been studied in patients with idiopathic nephrotic syndrome (INS). This study investigates the association of class II HLA alleles and the treatment outcome in children with steroid-dependent nephrotic syndrome (SDNS) who were treated with CYC. Methods A total of 77 children who were diagnosed with SDNS and had received CYC at least a year before were enrolled. After obtaining informed consent from the parents, blood samples were collected to type the HLA class II locus (DR and DQ) using sequence-specific primers (SSP). An equal number of adult healthy controls (AHC) were included. Results The median age of the study participants at disease onset was five (IQ: 3-7) years with a male-to-female ratio of 1.48:1. The common HLA alleles found in the study cohort and controls were DRB1*7 45 (29%), DRB1*15 30 (19.5%), and DQB1*2 57 (37%), and DRB1*15 31(20%), DRB1*17 36 (23%), DQB1*6 42 (27%), and DQB1*2 38 (25%), respectively. Identification of a particular allele to predict a good or poor response was not statistically significant (p-value >0.05). Conclusion The study demonstrates the common HLA alleles in the cohort. However, a specific allele that can predict a good and poor response to CYP was not identified. Further large-scale, prospective multicenter studies are needed to identify such alleles to decide the use of CYC in the SDNS population judiciously.

Incidence and Relapse of Idiopathic Nephrotic Syndrome: Meta-analysis

CONTEXT

Idiopathic nephrotic syndrome (INS) in children is a disease with considerable morbidity, yet the incidence and risk for relapse have not been systematically reviewed.

OBJECTIVE

To estimate the overall pooled weighted incidence and risk for relapse of INS in children.

DATA SOURCES

Medline and Embase (until December 2020).

STUDY SELECTION

All studies reporting incidence (per 100 000 children per year) and/or risk for relapse (the proportion of patients who experience ≥1 relapse) of INS in children (age: <18 years) were eligible.

DATA EXTRACTION

After quality assessment, data were extracted: study (design, localization, and sample size) and patient (age, sex, steroid response, and ethnicity) characteristics, incidence, and risk for relapse.

RESULTS

After screening, 73 studies were included for analysis (27 incidence, 54 relapse). The overall pooled weighted estimate and corresponding prediction interval (PI) of the incidence was 2.92 (95% PI: 0.00-6.51) per 100 000 children per year. Higher incidences were found in non-Western countries (P < .001). Incidence tended to be lower in white children, but this was not significant. The overall pooled weighted estimate of the risk for relapse was 71.9% (95% PI: 38.8-95.5). Between 1945 and 2011, incidence did not change (P = .39), yet the risk for relapse decreased significantly (P = .024), from 87.4% to 66.2%.

LIMITATIONS

There was no full-text availability (n = 33), considerable heterogeneity, and limited studies from Africa, Latin America, and Asia.

CONCLUSIONS

INS has a low incidence with ethnic variation but high risk for relapse. Although corticosteroids have significantly reduced the risk for relapse, it remains unacceptably high, underscoring the need for alternative treatment strategies.

Glucocorticoid treatment facilitates development of a metabolic syndrome in ovariectomized Macaca Mulatta fed a high fat diet

Metabolic syndrome (MetS) is characterized by a cluster of key features, which include abdominal obesity, insulin resistance, hypertension, and dyslipidemia. The aim of this study was to assess the impact of elevated glucocorticoid levels on the development of MetS in middle-aged female rhesus monkeys (Macaca Mulatta) after ovariectomy. Six female ovariectomized rhesus monkeys (9-13years) were randomly assigned to either a control group (normal diet, n=3) or a group in which MetS was facilitated (n=3). The MetS group fed with HFD (15% fat) and received oral prednisone acetate treatment (50mg/day). After 24months, the GCs treatment was withdrawn with continuation of high-fat feeding for a further 12months. After 24months, the MetS group displayed a significant increase in body weight and abdominal circumference. Additionally, the MetS animals displayed abnormal serum lipids, insulin resistance and impaired glucose tolerance. Histology of liver biopsies indicated marked accumulation of lipid droplets in hepatocytes of MetS animals. Withdrawal of GCs treatment led to recovery from above-mentioned metabolic disorders. Whereas GCs treatment increased leptin expression, it lowered expression of adiponectin and other factors in adipose tissue. Expression of Hydroxy-steroid dehydrogenase-1 and glucose transporter type-4 in the livers of MetS animals were reduced. We conclude that in the context of high fat diet, high levels of exogenous GCs contribute to the development of MetS in non-human primates.