Document Detail


The effect of steroids on lymphocyte profile in primary chronic glomerulonephritis. Empirical or tailored therapy?
MedLine Citation:
PMID:  17630206     Owner:  NLM     Status:  MEDLINE    
Abstract/OtherAbstract:
Steroids are still the mainstay of therapy in primary chronic glomerulonephritis (PCGN), regardless of underlying disturbance or pathology. Moreover, relationship between known abnormalities and disease manifestation is stochastic, therefore treatment continues to be empirical. It is not known whether responsiveness is related to immune phenotype. We performed flowcytometric lymphocyte (Ly) phenotyping (CD19, CD3, CD3CD4, CD3CD8, CD56/16) on 16 patients (pts) (12M, 4F), mean age 37.6+/-13 years with primary chronic glomerulonephritis (PCGN): minimal change disease (MCD)--6 pts, focal and segmental glomerulosclerosis (FSGS)--4 pts, mesangial proliferative glomerulonephritis--5 pts, mesangiocapillary glomerulonephritis--1 pt, before and at 7 days of oral Prednisone 1 mg/kg/day (in 2 divided doses). Before steroids: 4/16 pts(25%) had elevated BP; 9/16(56.2) showed nephrotic proteinuria. Serum creatinine was >1.2 mg% in 6/16(37.5%). At 7 days WBC count increased (13,079.37+/-4966.4/microl vs. 8021.25+/-2077.4/microl; p=0.0007), Ly percentage (%) decreased (20.30+/-9% vs. 29.9+/-10.4%; p=0.0095), while absolute (abs.) Ly count remained unchanged. Both CD19 Ly% and CD19 Ly abs. count increased (16.13+/-6.5% vs. 9.52+/-3.7%; p=0.0015, and 410.012+/-29.7/microl vs. 223.56+/-123.8/microl; p=0.0077, respectively). NK (natural killer)% decreased (9.15+/-5.2% vs. 14.19+/-7.1%; p=0.0296). CD3, CD3CD4, CD3CD8 Ly subsets and CD4/CD8 ratio showed no change. Variation in proteinuria (2.88+/-2.1 g/24 h vs. 3.45+/-1.7 g/24 h; p=0.4) did not reach statistical significance (Wilcoxon-Mann-Whitney). In 11 pts we performed an additional analysis at 1 month. Compared to levels before steroids, there was an increase in WBC, CD19 Ly% and CD19 Ly abs. count and a decrease in NK% and NK abs. count. Other Ly subsets and CD4/CD8 ratio remained unchanged. Variation in clinical parameters (proteinuria, serum Creatinine, BP) did not reach statistical significance. Changes in Ly profile precede changes in clinical parameters and thus are divergent. While our patients proved to be early non-responders, further studies to elucidate whether profile changes provide for response specification are warranted.
Authors:
Cristina Gluhovschi; Gheorghe Gluhovschi; Diana Herman; Elena Potencz; Virginia Trandafirescu; Adalbert Schiller; Ligia Petrica; Silvia Velciov; Gheorghe Bozdog; Flaviu Bob; Calin Muntean; Corina Vernic; Valentin Guset; Daniel Cioca
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Publication Detail:
Type:  Journal Article     Date:  2007-06-15
Journal Detail:
Title:  International immunopharmacology     Volume:  7     ISSN:  1567-5769     ISO Abbreviation:  Int. Immunopharmacol.     Publication Date:  2007 Sep 
Date Detail:
Created Date:  2007-07-16     Completed Date:  2007-10-12     Revised Date:  -    
Medline Journal Info:
Nlm Unique ID:  100965259     Medline TA:  Int Immunopharmacol     Country:  Netherlands    
Other Details:
Languages:  eng     Pagination:  1265-70     Citation Subset:  IM    
Affiliation:
University of Medicine and Pharmacy Timisoara, Romania. gluhovschi@yahoo.com
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MeSH Terms
Descriptor/Qualifier:
Adolescent
Adult
Chronic Disease
Female
Glomerulonephritis / drug therapy*,  immunology
Glucocorticoids / therapeutic use*
Humans
Immunophenotyping
Longitudinal Studies
Lymphocytes / drug effects*,  immunology
Male
Middle Aged
Chemical
Reg. No./Substance:
0/Glucocorticoids

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