Description and immunological findings

Abstract

Summary Three cases are described showing a seasonal exacerbation of their nephrotic syndrome in association with an atopic trait and grass pollen allergy. The first patient has a history of four consecutive seasonal relapses each requiring steroid therapy. Following a course of desensitization injections he has now been free of relapse for 3 consecutive years. The second patient has also had a recurrent steroid‐sensitive nephrotic syndrome often associated with the pollen season and allergic rhinitis. In this patient a course of cyclophosphamide has reduced his tendency to relapse. The third patient who has been on continuous prednisone therapy shows a seasonal increase in proteinuria. Serum changes in the first two patients include: a seasonal rise in total and grass pollen specific IgE; the continued presence of grass pollen specific IgG throughout the year but with a reduction during the pollen season in association with a more pronounced fall in the total IgG level; a depression in the C3 level in association with each major relapse; a mild rise in the I‐K titre and a positive result in the C1q test for circulating complexes. A renal biopsy performed on the first patient when in relapse showed minor histological changes only and IgG. IgM, IgA, IgD, IgE, C3 and fibrinogen were undetectable by immunofluorescent examination. The probable mechanism for the development of proteinuria in these patients is discussed.

Is Adult Idiopathic Nephrotic Syndrome Food Allergy?

“…The role of hypersensitivity to environmental antigens in idiopathic nephrotic syndrome (INS) remains con troversial [1], Since 1957, there have been several isolated reports of relapses of INS following contact with respira tory antigens; because of the seasonal onset of these exacerbations, the first of these reported cases were asso ciated with pollens [2][3][4], Later, other respiratory anti gens such as mould [5], house dust [6] and wheat flour antigens [7] were incriminated. Although the number of such reported cases is small, Fontana et al [8] have documented a high incidence of atopy in INS patients.…”

Potential Role of Soluble ST2 Protein in Idiopathic Nephrotic Syndrome Recurrence Following Kidney Transplantation

“…Moreover, several studies pointed out the ST2 protein as a selective marker of Th2 cells [10][11][20][21] , which correlates with the atypical Th2 polarization described in INS [22][23][24] . Finally, sST2 seems to be tightly associated with allergic airways inflammation [12][13][14] , which have also been associated with some cases of nephrotic syndrome [25][26][27] .…”

Risk of idiopathic nephrotic syndrome among children with asthma: a nationwide, population-based cohort study

“…Numerous studies have associated INS with allergy risk of clinical and immunological features (2)(3)(4)(5)(6)(7)(8)(9)(10)(11). In the 1950s through the 1970s, few anecdotal reports described patients who developed INS after allergic reactions to inhaled allergens, vaccinations, food, or insect stings (2)(3)(4)(5).…”

“…Numerous studies have associated INS with allergy risk of clinical and immunological features (2)(3)(4)(5)(6)(7)(8)(9)(10)(11). In the 1950s through the 1970s, few anecdotal reports described patients who developed INS after allergic reactions to inhaled allergens, vaccinations, food, or insect stings (2)(3)(4)(5). Since 1970, several case-control studies revealed that elevated serum IgE and atopic diathesis were more common in children with INS than non-INS controls (9,(11)(12)(13)(14)(15)(16)(17).…”

“…Children with INS commonly have elevated serum levels of immunoglobulin E (IgE), which also plays a central role in allergic inflammation (11)(12)(13)(14)(15)(16). Although clinical and immunological studies have shown a possible link between allergic diseases and INS for 50 y, human epidemiologic study using a large cohort to investigate the relationship between these disorders are lacking (2)(3)(4)(5)(6)(7)(8)(9)(10)(11). Asthma is one of the most common allergic disease in childhood, affects a multitude of patients worldwide (22).…”