Idiopathic Nephrotic Syndrome and Atopy: Is There a Common Link?

Abstract

Numerous reports during the last 60 years have reported a strong association between idiopathic nephrotic syndrome and atopic disorders. Idiopathic nephrotic syndrome can be precipitated by allergic reactions and has been associated with both aeroallergens (pollens, mold, and dust) and food allergies. Patients with idiopathic nephrotic syndrome also may show increased serum immunoglobulin E (IgE) levels. A review of the literature suggests that although some idiopathic nephrotic syndrome cases may be associated with allergies, evidence that it is a type of allergic disorder or can be induced by a specific allergen is weak. Rather, it is likely that the proteinuria and increased IgE levels in patients with idiopathic nephrotic syndrome are caused by increased levels of interleukin 13 observed in these patients. Recent studies suggest that interleukin 13, a known stimulator of IgE response, may mediate proteinuria in patients with minimal change disease because of its ability to directly induce CD80 expression on the podocyte. KeywordsAtopy; nephrotic syndrome; minimal change disease Idiopathic nephrotic syndrome in children is a clinical syndrome associated with a variety of glomerular lesions. Minimal change disease (MCD) is the most common cause of idiopathic nephrotic syndrome. MCD is often abrupt in onset. It can be dramatic in presentation, yet is one of the most rewarding diseases for a physician to manage because response to corticosteroids often is rapid and complete. Because kidney biopsy usually is not performed when the disease responds to corticosteroid therapy, the term MCD has become synonymous with steroid-sensitive nephrotic syndrome. The mechanism(s) underlying the MCD pathogenesis are unknown, although it is believed to be immunologically mediated. 1 Strong evidence suggests that it may be caused by a circulating factor, possibly T-cell related, that causes podocyte dysfunction resulting in massive proteinuria. 2 However, there also have been numerous reports linking MCD with atopic disorders and increases in serum immunoglobulin E (IgE) levels. In this review, we discuss the evidence supporting the association of atopy and whether there may be a common underlying immune disorder that may predispose patients to both conditions. ATOPYAtopy is a term used to describe IgE-mediated diseases. Persons with atopy have a hereditary predisposition to produce IgE antibodies to common allergens and often manifest with 1 or more atopic diseases (asthma, allergic rhinitis, and atopic eczema). Atopic patients mount an exaggerated immunologic response characterized by production of allergen-specific IgE antibodies and positive reactions to extracts of common aeroallergens on skin-prick tests. Type 2 helper T cells (T H 2) from patients with atopy respond to allergens in vitro by expressing such cytokines as interleukin 4 (IL-4) and IL-13 3 (Fig 1A and B). Early Reports of Atopy With MCDIn 1951, Fanconi et al 4 were among of the first to associate atopy and nephrotic syndrome. Forty-three percent of th...

Evaluation of children with steroid-sensitive nephrotic syndrome in terms of allergies

“…2,3 In many studies, increased incidence of allergic diseases and high serum IgE levels have been reported in SSNS. 2,[4][5][6]9,[16][17][18][19] These findings support the existence of a dysfunction of the humoral immune response in the nephrotic syndrome. 4,6,7,18,19 The term ''atopy'' is used to define IgE-mediated diseases.…”

“…As it has been stated in the past, the belief today too is that the immune system plays an important role in this condition. [5][6][7][8][9] In particular, there is strong evidence pointing to T-cell disorder mediated by a circulating factor that creates podocyte dysfunction and massive proteinuria. 2,3 In many studies, increased incidence of allergic diseases and high serum IgE levels have been reported in SSNS.…”

“…1,4,9 The different rates related to patients' histories of atopy seem to be resulting from the use of different criteria in the defining of the condition. The present study found an atopic rate of 36% in children with SSNS, a finding that is consistent with the literature.…”

“…As a result of T regulatory (Treg) cell disfunction, pathological cytokines would be produced continuously together with the increase in serum IgE levels and proteinuria. 9 Fusion in food processes and proteinuria were observed by the induction of CD80 in rats. 10,11 High levels of CD80 in urine and biopsy materials of the rats with MCD were reported in different experimental studies.…”

“…10,11 High levels of CD80 in urine and biopsy materials of the rats with MCD were reported in different experimental studies. 9,12 The aim of this study was to evaluate the atopy of the children with SSNS.…”