title: Changes of lymphocyte populations in pediatric steroid-sensitive nephrotic syndrome are more pronounced in remission than in relapse.
abstract: OBJECTIVE
  Although clinical and immunological findings in steroid-sensitive nephrotic syndrome (SSNS) favor an immunopathogenesis, many issues remain unsolved. Comprehensive studies analyzing cellular and humoral immunity in SSNS are scarce, and few studies addressed the effect of steroids on immunological factors.
  
  
  METHODS
  We therefore performed a cross-sectional study of T and B lymphocyte populations in 89 children during the different stages of the disease and related the findings to parameters of humoral immunity and treatment with steroids.
  
  
  RESULTS
  In untreated relapse, an increase in the proportion of activated CD3+ lymphocytes with a concomitant reduction of CD19+ B cells was noted compared to healthy controls. Conversely, patients with steroid dependency, relapsing on alternate-day steroids, showed a decline of the absolute numbers as well as proportion of CD4+ lymphocytes but a relative increase in CD19+ B cells, compared to healthy controls. Also untreated remission was characterized by an absolute and relative decrease in CD4+ lymphocytes compared to healthy controls which was accompanied by a significant increase in the proportion of CD8+ and also activated CD3+ lymphocytes. Steroid-induced remission resulted in suppression of absolute and relative CD4+, while absolute and relative B cells were upregulated in this group compared to untreated remission.
  
  
  CONCLUSIONS
  Alterations of lymphocyte populations in SSNS are not limited to relapse but seem to be more pronounced in remission and show a different profile with steroid treatment. Changes of lymphocyte populations do not only affect T but also B lymphocytes, which may be of relevance in the pathogenesis of this disorder.
authors.affiliation: Pediatric Nephrology, University Children's Hospital, Hamburg, Germany. Kemper@uke.uni-hamburg.de
authors.forename: Markus J
authors.initials: MJ
authors.lastname: Kemper
authors.forename: Kristina
authors.initials: K
authors.lastname: Zepf
authors.forename: Ilka
authors.initials: I
authors.lastname: Klaassen
authors.forename: Amrey
authors.initials: A
authors.lastname: Link
authors.forename: Dirk E
authors.initials: DE
authors.lastname: Muller-Wiefel
mesh_terms: D000293:Adolescent; D000305:Adrenal Cortex Hormones / Q000627:therapeutic use; D000328:Adult; D001402:B-Lymphocytes / Q000276:immunology; D002648:Child; D002675:Child, Preschool; D003430:Cross-Sectional Studies; D006801:Humans; D016131:Lymphocyte Subsets / Q000276:immunology*; D009404:Nephrotic Syndrome / Q000188:drug therapy / Q000276:immunology*; D012008:Recurrence; D012075:Remission, Spontaneous; D013601:T-Lymphocytes / Q000276:immunology
chemical_list: D000305:Adrenal Cortex Hormones