Intermittent high-volume hemofiltration promotes remission in steroid-resistant idiopathic nephrotic syndrome

Abstract

Inflammation is a key part in the etiology and progression of idiopathic nephrotic syndrome (INS), we hypothesize that removing pro-inflammatory cytokines with intermittent high-volume hemofiltration (IHVHF) could improve the outcome in INS patients. The purpose of the current study is to examine whether IHVHF promotes remission in steroid-resistant INS. Fifty-one steroid-resistant INS patients were followed up on an open-label basis with prospective evaluations. Thirty-five patients received mycophenolate mofetil (SRD group) and 16 patients received drugs and IHVHF due to volume overload despite of diuretics (SRDF group). The rate of complete remission (CR) was analyzed. We also recruited 30 healthy individuals and 36 steroid-sensitive (SS) INS patients as controls to investigate the correlation of interleukin (IL)-8, IL-10, IL-6 and IL-17 with INS activity. Compared with the patients in the SRD group, the 6-month CR rate was higher (44% vs. 9%, p50.001) and time to first CR was significantly shorter (7.3 ± 3.6 vs. 11.1 ± 5.3 months, p ¼ 0.02) in the SRDF group. Serum IL-8 was highest in the SRDF group and reduced by IHVHF clearance. Serum IL-8 was lower during remission than at onset or recurrence of INS, whereas no significant difference was seen in the other cytokines. Receiver operating characteristic curve analysis demonstrated that serum IL-8 predicted steroid sensitivity with moderate accuracy (area under the curve ¼ 0.79, 95% CI: 0.69-0.87). IHVHF promotes remission in patients with steroid-resistant INS and it may be partly due to serum IL-8 clearance.

High urinary interleukin‐8 levels is associated with poor prognosis in idiopathic membranous nephropathy

“…Our studies indicated that only serum IL‐8 levels were significantly increased in patients with steroid‐resistance when compared to steroid‐sensitive INS. Further studies indicated that intermittent high‐volume haemofiltration (IHVHF) promoted remission in steroid‐resistant INS patients with volume overload and accompanied with IL‐8 serum levels decreased, therapeutic efficacy of IHVHF may partly be due to serum IL‐8 clearance. However, whether IL‐8 levels can be used to evaluate the prognosis of IMN remains unknown.…”

Blocking core fucosylation of epidermal growth factor (EGF) receptor prevents peritoneal fibrosis progression

“…During peritoneal equilibrium test, peritoneal cavity fluid was collected and spun down to remove cellular debris, and then the supernatants were frozen at −80 °C until assay of monocyte chemoattractant protein-1 (MCP-1) by Enzyme-linked immunosorbent assay (ELISA) with ELISA kits (R&D System, Minneapolis, MN) as describled in our previous study [ 19 ].…”

NOX-mediated impairment of PDGF-induced DNA synthesis in peripheral blood lymphocytes of children with idiopathic nephrotic syndrome

“…The fact that all patients recruited in this study were not taking any steroid treatment for a period of at least 2 months, there would be an enhanced risk of inflammation and production of certain proinflammatory cytokines, which are known to activate NOX (22). The efficacy of steroids and immunosuppressive treatments in INS implies the involvement of cytokines and immunogenic molecules in pathophysiology of the disease (23). An increase in the expression of Toll-like receptors and interleukin-6 has been linked to INS pathogenesis, and activation of NADPH oxidase has been independently reported to occur through Toll-like receptors and cytokines (24,25).…”