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Mulat SY, Mihajlović M, Antonić T, Miloševski-Lomić G, Peco-Antić A, Jovanović D, Paripović D, Stefanović A. Pediatric nephrotic syndrome: The interplay of oxidative stress and inflammation. J Med Biochem 2024; 43:424-435. [PMID: 39139165 PMCID: PMC11318042 DOI: 10.5937/jomb0-46526] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/27/2023] [Accepted: 12/18/2023] [Indexed: 08/15/2024] Open
Abstract
Background The pathophysiological mechanisms crucial in the development of nephrotic syndrome (NS) in the pediatric population are still not fully understood. This study aimed to investigate the relationship between hypertension, oxidative stress, and inflammation in pediatric patients during the acute phase of the disease. Methods The study included 33 children, aged 2 to 9 years, with nephrotic syndrome. Blood samples were collected during the acute phase and remission. Parameters of oxidative status were determined, including total oxidative status (TOS), advanced oxidation protein products (AOPP), prooxidant-antioxidant balance (PAB), sulfhydryl groups (-SH), paraoxonase 1 (PON1), and total antioxidant status (TAS) in serum, measured spectrophotometrically. Inflam - matory parameters such as pentraxin 3 (PTX3), leptin, program med cell death ligand 1 (PD-L1), and E-cadherin were determined using enzyme-linked immunosorbent assay (ELISA). Results Patients with nephrotic syndrome and hypertension had significantly higher levels of advanced oxidation protein products and total antioxidant status (p=0.029 and p=0.003, respectively). During the acute phase of the disease, lower activity of sulfhydryl groups and paraoxonase 1 was observed compared to remission (p<0.001, for both). Pentraxin 3 levels were higher, while leptin levels were lower during the acute phase (p<0.001, for both). Pentraxin 3 correlated with advanced oxidation protein products and total antioxidant status during the acute phase but not in remission (rs=0.42, p=0.027 and rs=0.43, p=0.025, respectively). A negative correlation between Advanced oxidation protein products and leptin was observed during the acute phase, which disappeared in remission (rs=-0.42, p=0.028). Conclusions Results of this study show that hypertension influences oxidative stress markers, and decreased antioxidant capacity may contribute to nephrotic syndrome development. Pentraxin 3 appears as a potential disease activity marker, indicating a dynamic connection between inflammation and oxidative stress. Leptin may also play a role in oxidative stress in nephrotic syndrome.
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Affiliation(s)
- Simachew Yonas Mulat
- University of Belgrade, Faculty of Pharmacy, Department of Medical Biochemistry, Belgrade
| | - Marija Mihajlović
- University of Belgrade, Faculty of Pharmacy, Department of Medical Biochemistry, Belgrade
| | - Tamara Antonić
- University of Belgrade, Faculty of Pharmacy, Department of Medical Biochemistry, Belgrade
| | | | - Amira Peco-Antić
- University Children's Hospital, Department of Nephrology, Belgrade
| | | | - Dušan Paripović
- University Children's Hospital, Department of Nephrology, Belgrade
| | - Aleksandra Stefanović
- University of Belgrade, Faculty of Pharmacy, Department of Medical Biochemistry, Belgrade
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Jia W, Dou W, Zeng H, Wang Q, Shi P, Liu J, Liu Z, Zhang J, Zhang J. Diagnostic value of serum CRP, PCT and IL-6 in children with nephrotic syndrome complicated by infection: a single center retrospective study. Pediatr Res 2024; 95:722-728. [PMID: 37773440 DOI: 10.1038/s41390-023-02830-9] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/21/2023] [Revised: 08/17/2023] [Accepted: 09/03/2023] [Indexed: 10/01/2023]
Abstract
OBJECTIVE The purpose was to look into the diagnostic value of serum CRP, PCT and IL-6 in children with nephrotic syndrome co-infection. METHODS One hundred and forty-nine children with nephrotic syndrome who met the inclusion and exclusion criteria were included in this study. The children were divided into three groups: bacterial infection group, non-bacterial infection group, and non-infection group. The diagnostic value was analyzed and compared using the ROC curve. RESULTS There was no statistically significant difference in the Leukocyte counts among three groups. The mean results of serum CRP, PCT and IL-6 were significantly higher in the bacterial infection group compared to those in the non-infection group (p < 0.05). AUC of CRP, PCT, IL-6 in bacterial infection were 0.791, 0.859, 0.783. The following combinations CRP + PCT + IL-6, IL-6 + PCT, CRP + PCT significantly increased the efficiency of bacterial infection diagnosis, the AUCs were 0.881, 0.884, and 0.884, respectively. AUC of PCT in non-bacterial infection was 0.663. The combinations of these three clinical indicators performed no better than PCT in ROC analysis. CONCLUSION Normal CRP or IL-6 levels do not rule out the diagnosis of bacterial infection in children on long-term glucocorticoid therapy. The appropriate combination of two or three indicators can improve the diagnostic value. IMPACT This study evaluated the diagnostic value of the serum concentrations of CRP, PCT and IL-6 and assessed whether the value of their combined application is better than when used alone for diagnosing primary nephrotic syndrome complicated by infection. The elevation in leukocyte count cannot be used to diagnose children with nephrotic syndromes on long-term glucocorticoid treatment who have bacterial infections. Normal CRP or IL-6 levels do not rule out the diagnosis of bacterial infection in children on long-term glucocorticoid therapy. The appropriate combination of two or three indicators can improve diagnostic value, sensitivity, and specificity.
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Affiliation(s)
- Wanyu Jia
- Department of Pediatrics, the First Affiliated Hospital of Zhengzhou University, Clinical Center of Pediatric Nephrology of Henan Province, Zhengzhou, 450052, China
| | - Wenjie Dou
- Department of Pediatrics, the First Affiliated Hospital of Zhengzhou University, Clinical Center of Pediatric Nephrology of Henan Province, Zhengzhou, 450052, China
| | - Huiqin Zeng
- Department of Pediatrics, the First Affiliated Hospital of Zhengzhou University, Clinical Center of Pediatric Nephrology of Henan Province, Zhengzhou, 450052, China
| | - Qin Wang
- Department of Pediatrics, the First Affiliated Hospital of Zhengzhou University, Clinical Center of Pediatric Nephrology of Henan Province, Zhengzhou, 450052, China
| | - Peipei Shi
- Department of Pediatrics, the First Affiliated Hospital of Zhengzhou University, Clinical Center of Pediatric Nephrology of Henan Province, Zhengzhou, 450052, China
| | - Jing Liu
- Department of Nephrology, Shanghai Tongji Hospital, Tongji University School of Medicine, Shanghai, China
| | - Zhen Liu
- Department of Pediatrics, the First Affiliated Hospital of Zhengzhou University, Clinical Center of Pediatric Nephrology of Henan Province, Zhengzhou, 450052, China
| | - Jin Zhang
- Department of Pediatrics, the First Affiliated Hospital of Zhengzhou University, Clinical Center of Pediatric Nephrology of Henan Province, Zhengzhou, 450052, China
| | - Jianjiang Zhang
- Department of Pediatrics, the First Affiliated Hospital of Zhengzhou University, Clinical Center of Pediatric Nephrology of Henan Province, Zhengzhou, 450052, China.
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Kitsou K, Askiti V, Mitsioni A, Spoulou V. The immunopathogenesis of idiopathic nephrotic syndrome: a narrative review of the literature. Eur J Pediatr 2022; 181:1395-1404. [PMID: 35098401 DOI: 10.1007/s00431-021-04357-9] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/16/2021] [Revised: 10/21/2021] [Accepted: 12/19/2021] [Indexed: 12/18/2022]
Abstract
UNLABELLED Idiopathic nephrotic syndrome (INS) is a common glomerular disease in childhood, and the immunological involvement in the pathogenesis of non-genetic INS, although not fully elucidated, is evident. This narrative review aims to offer a concise and in-depth view of the current knowledge on the immunological mechanisms of the development of INS as well as the role of the immunological components of the disease in the responsiveness to treatment. T cell immunity appears to play a major role in the INS immunopathogenesis and has been the first to be linked to the disease. Various T cell immunophenotypes are implicated in INS, including T-helper-1, T-helper-2, T-helper-17, and T regulatory cells, and various cytokines have been proposed as surrogate biomarkers of the disease; however, no distinct T helper or cytokine profile has been conclusively linked to the disease. More recently, the recognition of the role of B cell mediated immunity and the various B cell subsets that are dysregulated in patients with INS have led to new hypotheses on the underlying immunological causes of INS. Finally, the disambiguation of the exact mechanisms of the INS development in the future may be the key to the development of more targeted personalized approaches in managing INS. CONCLUSIONS INS demonstrates particularly interesting immunopathogenetic pathways, in which multiple interactions between T cell and B cell immunity and the podocyte are involved. The disambiguation of these pathways will provide promising novel therapeutic targets in INS. WHAT IS KNOWN • INS is the most common glomerular disease in the paediatric population, and its onset and relapses have been linked to various immunological triggers. • Multiple immunological mechanisms have been implicated in the pathogenesis of INS; however, no single distinct immunological profile has been recognized. WHAT IS NEW • Th17 cells and Treg cells play an important role in the immune dysregulation in INS. • Transitional B cell levels as well as the transitional/memory B cell ratio have been correlated to nephrotic relapses and have been proposed as biomarkers of INS relapses in SSNS patients.
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Affiliation(s)
- Konstantina Kitsou
- Immunobiology and Vaccinology Research Laboratory, First Department of Paediatrics, School of Medicine, "Aghia Sophia" Children's Hospital, National and Kapodistrian University of Athens, Athens, Greece.
| | - Varvara Askiti
- Department of Nephrology, "P. and A. Kyriakou" Children's Hospital, Athens, Greece
| | - Andromachi Mitsioni
- Department of Nephrology, "P. and A. Kyriakou" Children's Hospital, Athens, Greece
| | - Vana Spoulou
- Immunobiology and Vaccinology Research Laboratory, First Department of Paediatrics, School of Medicine, "Aghia Sophia" Children's Hospital, National and Kapodistrian University of Athens, Athens, Greece
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Chen S, Wang J, Liang S. Clinical significance of T lymphocyte subsets, immunoglobulin and complement expression in peripheral blood of children with steroid-dependent nephrotic syndrome/frequently relapsing nephrotic syndrome. Am J Transl Res 2021; 13:1890-1895. [PMID: 33841716 PMCID: PMC8014369] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/25/2020] [Accepted: 12/04/2020] [Indexed: 06/12/2023]
Abstract
OBJECTIVE To investigate the clinical significance of T lymphocyte subsets, immunoglobulin and complement expression in the peripheral blood of children with steroid-dependent nephrotic syndrome/frequently relapsing nephrotic syndrome (SDNS/FRNS). METHODS A prospective study was conducted on 285 children with nephrotic syndrome (NS). Among the 285 patients, 187 children had steroid-sensitive nephrotic syndrome (SSNS) and 98 children had SDNS/FRNS according to their sensitivity to hormones. Meanwhile, 50 healthy children in the same period were selected as the control group. Serum albumin (ALB), blood urea nitrogen (BUN), serum creatinine (SCr), estimated glomerular filtration rate (eGFR), high-sensitivity C-reactive protein (hs-CRP), interleukin-6 (IL-6), CD3+, CD4+, CD8+, immunoglobulin IgA, IgG, IgM and complement C3 and C4 were measured upon admission, and the content of urinary CD80 was also determined. RESULTS Compared with the control group, BUN, SCr, hs-CRP and IL-6 levels, urinary CD80, IgA, IgM and C3 in the SDNS/FRNS and SSNS groups were significantly higher, while ALB, eGFR, CD3+, CD4+, CD4+/CD8+, IgG and IgG/IgM were significantly lower (all P<0.05). Compared with the SSNS group, BUN, SCr, hs-CRP and IL-6 levels in the SDNS/FRNS group were significantly higher, while ALB and eGFR levels were significantly lower (all P<0.05). Compared with the SDNS/FRNS group, IgM in the SSNS group was significantly lower, while CD4+/CD8+, urinary CD80 and IgG/IgM were significantly higher (all P<0.001). CONCLUSION Renal function decline and inflammatory response existed in children with NS. CD3+, CD4+, CD4+/CD8+ and IgG/IgM in peripheral blood were decreased, while IgA, IgM, C3 and urinary CD80 were increased. Moreover, renal function decline, increase of inflammatory factors, decrease of IgG/IgM and CD4+/CD8+ were more obvious in the SDNS/FRNS group.
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Affiliation(s)
- Shulian Chen
- Department of Pediatrics, Quanzhou First Hospital Affiliated to Fujian Medical University Quanzhou, Fujian Province, China
| | - Jianxin Wang
- Department of Pediatrics, Quanzhou First Hospital Affiliated to Fujian Medical University Quanzhou, Fujian Province, China
| | - Shishan Liang
- Department of Pediatrics, Quanzhou First Hospital Affiliated to Fujian Medical University Quanzhou, Fujian Province, China
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McLeod DJ, Sebastião YV, Ching CB, Greenberg JH, Furth SL, Becknell B. Longitudinal kidney injury biomarker trajectories in children with obstructive uropathy. Pediatr Nephrol 2020; 35:1907-1914. [PMID: 32444926 PMCID: PMC7502482 DOI: 10.1007/s00467-020-04602-7] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/20/2020] [Revised: 05/01/2020] [Accepted: 05/05/2020] [Indexed: 12/24/2022]
Abstract
BACKGROUND Congenital obstructive uropathy (OU) is a leading cause of pediatric kidney failure, representing a unique mechanism of injury, in part from renal tubular stretch and ischemia. Tubular injury biomarkers have potential to improve OU-specific risk stratification. METHODS Patients with OU were identified in the Chronic Kidney Disease in Children (CKiD) study. "Cases" were defined as individuals receiving any kidney replacement therapy (KRT), while "controls" were age- and time-on-study matched and KRT free at last study visit. Urine and plasma neutrophil gelatinase-associated lipocalin (NGAL), interleukin 18 (IL-18), and liver-type fatty acid-binding protein (L-FABP) levels were measured at enrollment and annually and compared between cases and controls. Urine values were normalized to urine creatinine. RESULTS In total, 22 cases and 22 controls were identified, with median (interquartile range) ages of 10.5 (9.0-13.0) and 15.9 (13.9-16.9) years at baseline and outcome, respectively. At enrollment there were no differences noted between cases and controls for any urine (u) or plasma (p) biomarker measured. However, the mean pNGAL and uL-FABP/creatinine increased throughout the study period in cases (15.38 ng/ml per year and 0.20 ng/ml per mg/dl per year, respectively, p = 0.01 for both) but remained stable in controls. This remained constant after controlling for baseline glomerular filtration rate (GFR). CONCLUSIONS In children with OU, pNGAL and uL-FABP levels increased over the 5 years preceding KRT; independent of baseline GFR. Future studies are necessary to identify optimal cutoff values and to determine if these markers outperform current clinical predictors.
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Affiliation(s)
- Daryl J McLeod
- Section of Urology, Nationwide Children's Hospital, Columbus, OH, 43205, USA.
- Center for Surgical Outcomes Research, Nationwide Children's Hospital, Columbus, OH, 43205, USA.
| | - Yuri V Sebastião
- Center for Surgical Outcomes Research, Nationwide Children's Hospital, Columbus, OH, 43205, USA
| | - Christina B Ching
- Section of Urology, Nationwide Children's Hospital, Columbus, OH, 43205, USA
- Center for Clinical and Translational Research, Nationwide Children's Hospital, Columbus, OH, 43205, USA
| | - Jason H Greenberg
- Department of Pediatrics, Section of Nephrology, Yale University School of Medicine, New Haven, CT, 06510, USA
| | - Susan L Furth
- Department of Pediatrics, Division of Nephrology, Perelman School of Medicine at the University of Pennsylvania and the Children's Hospital of Philadelphia, Philadelphia, PA, 19104, USA
| | - Brian Becknell
- Center for Clinical and Translational Research, Nationwide Children's Hospital, Columbus, OH, 43205, USA
- Department of Pediatrics, Section of Nephrology, Nationwide Children's Hospital, Columbus, OH, 43205, USA
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