TUMOR NECROSIS FACTOR-µ (TNF-µ) PRODUCTION FROM CULTURED PERIPHERAL BLOOD MONONUCLEAR CELLS (PBMC) IN CHILDREN WITH PRIMARY NEPHROTIC SYNDROME (PNS)

Bakr A, Shokeir M, El-Chenawy F, El-Ashry R

Mansoura University Children's Hospital, Mansoura, Egypt

 

Objective: To assess the role of TNF-µ in the pathogensis of PNS.

Methods: TNF-µ levels in supernatant fluid from cultured PBMC were measured by ELISA in 55 children with PNS, 10 patients with minimal change nephrotic syndrome (MCNS) in remission, and 10 healthy controls. Patients with active PNS were 21 patients with steroid-sensitive (SS)-MCNS, 6 patients with steroid¨Cresistant (SR)-MCNS, 11 with SR-focal segmental glomerulosclerosis (FSGS), 6 patients with SS-diffuse mesangial proliferation (DMP), 5 patients with SR-DMP and 6 patients had mesangiocapillary glomerulonephritis (MCGN).

Results: Patients with PNS of any pathological type had elevated TNF-a levels compared to controls. Patients with FSGS had the highest TNF-a levels compared to MCGN (P=0.015), DMP (P=0.006) and MCNS (P=0.002). TNF-a levels were elevated in MCNS¨CSR patients compared to MCNS-SS (P=0.019), while remission was associated with normalization of TNF-a levels. There was a positive correlation between TNF-a levels and the degree of proteinuria (r=0.34, P=0.013), degree of mesangial hypercellularity (r=0.42, P=0.028) and degree of glomerulosclerosis (r=0.46, P=0.001). By discriminate analysis, TNF-a levels at cut off point > 30 pg/ml, could be used to predict resistance to steroid therapy (sensitivity 92.9% specificity=93.2%). Moreover, TNF-a levels could be used to discriminate between patients with SR-MCNS, SR-FSGS and SR-DMP (sensitivity & specificity=100%).

Conclusion: TNF-a from cultured PBMCs might be responsible for glomerular abnormalities noticed in PNS of different pathological types. TNF-a levels in PBMC culture could be used to predict the pathological type of PNS and the response of these patients to steroid therapy.

 
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