Immunoglobulins in chronic renal failure of childhood: effects of dialysis modalities.
BACKGROUND
It is not clear whether low serum levels of IgG (subclasses), previously demonstrated in children on peritoneal dialysis (PD), are related to the PD procedure or to factors associated with chronic renal failure (CRF). The aim of our study was to analyze the effect of PD on serum and PD effluent (PDE) IgG and subclass levels in children with end-stage renal failure.


METHODS
We measured albumin, IgG, IgA, IgM, and IgG subclasses in serum and PDE from children on PD (N = 40) and compared the serum values with those of children treated with hemodialysis (HD, N = 23) or presenting with CRF but not yet dialyzed (CRF; N = 63), and with a group of healthy controls (HCs; N = 67). Sixteen PD children could be followed sequentially from before starting PD and eight during a peritonitis episode.


RESULTS
Forty percent of the PD children showed reduced serum IgG2 levels (P = 0.0003) compared with 35% in HD (P = 0.006), 33% in CRF (P = 0.001), and 9% in HC children. IgG1 deficiencies were observed in 25% of PD patients (P < 0.0001), 4% of HD (P = NS), 16% of CRF (P = 0.0005), and 0% of HC children. IgG3 and IgG4 deficiencies were observed less frequently. Peritoneal clearances were similar for total IgG, IgG1, IgG2, and IgG4, but were lower for IgG3 (P < 0.05). No relationships were found between clearances and age or duration of PD treatment. Total IgG (P = 0. 003) and IgG1 (P = 0.002) levels declined just after starting PD. Peritonitis was associated with temporarily increased peritoneal loss of Ig, while the serum concentrations were unaffected. No significant relationship was found between the peritonitis incidence and reduced IgG or subclasses. However, all children with two or more peritonitis episodes per year had a reduced Ig level.


CONCLUSIONS
Although the mean serum concentrations of immunoglobulins were normal in all studied groups, a deficiency of one or more IgG subclasses was present in all groups with renal failure, suggesting inhibition of their synthesis by the uremic state. Ig deficiencies were more frequently found in PD, likely caused by protein loss in PDE. A high peritonitis incidence was associated with reduced serum Ig levels.
Emma Children's Hospital, and Clinical and Laboratory Immunology Unit, Department of Internal Medicine, Academic Medical Center, Amsterdam, The Netherlands. A.H.Bouts@amc.uva.nl
A H
AH
Bouts
J C
JC
Davin
R T
RT
Krediet
M B
MB
van der Weel
C H
CH
Schröder
L
L
Monnens
J
J
Nauta
T A
TA
Out
D000208:Acute Disease; D000293:Adolescent; D000418:Albumins / Q000378:metabolism; D002648:Child; D002675:Child, Preschool; D003430:Cross-Sectional Studies; D015314:Dialysis Solutions / Q000493:pharmacokinetics; D005500:Follow-Up Studies; D006801:Humans; D007070:Immunoglobulin A / Q000032:analysis; D007074:Immunoglobulin G / Q000032:analysis; D007075:Immunoglobulin M / Q000032:analysis; D007136:Immunoglobulins / Q000032:analysis*; D007223:Infant; D007676:Kidney Failure, Chronic / Q000276:immunology* / Q000628:therapy*; D008137:Longitudinal Studies; D010530:Peritoneal Dialysis; D010537:Peritoneum / Q000378:metabolism; D010538:Peritonitis / Q000276:immunology / Q000628:therapy
D000418:Albumins; D015314:Dialysis Solutions; D007070:Immunoglobulin A; D007074:Immunoglobulin G; D007075:Immunoglobulin M; D007136:Immunoglobulins