Respiratory Tract Infection: A Risk Factor for the Onset and Relapse of Adult-Onset Minimal Change Disease in Southern China

Abstract

Aims/Introduction Steroid resistance and frequent relapse are problems in the treatment of minimal change disease (MCD). However, epidemiological factors that influence steroid-resistant and relapse of MCD are rarely reported. This study evaluated potential factors that influence the onset and relapse of MCD and the epidemiological features of southern Chinese patients with adult-onset MCD. Patients and Methods Patients with adult-onset MCD were included from the Affiliated Hospital of Guangdong Medical University, which is located in the southernmost part of China's mainland, between 2015 and 2016. Potential influencing factors were investigated. Results Eighty-seven patients with incipient MCD were enrolled, and 85 of these patients were followed up; 71.8% (61/85) were steroid-sensitive and 28.2% (24/85) were steroid-resistant. In terms of seasonal distribution, the highest rate of incipient cases was in spring (39.1%, 34/87), which also showed a high rate of relapse cases (29.7%, 22/74). Among patients who were followed up for more than half a year and whose proteinuria completely resolved (69.4%, 59/85), 52.5% (31/59) were without relapse and 47.5% (28/59) were with relapse. Patients without relapse were older than those with relapse (P<0.05). Before disease onset, 20.7% (18/87) of patients with incipient MCD were diagnosed with infection, including 94.5% (17/18) with respiratory tract infection. Fourteen patients in complete remission posttreatment developed an infection before relapse, including 85.7% (12/14) with respiratory tract infection. Conclusion Steroid resistance and frequent relapse are current challenges for the treatment of adult-onset MCD in southern China, and respiratory tract infection may be a risk factor for onset and relapse. Additionally, younger patients with MCD tend to have more frequent relapse.

Role of Arachidonic Acid and Its Metabolites in the Biological and Clinical Manifestations of Idiopathic Nephrotic Syndrome

“…It is well known that, in the course of nephrotic syndrome, infections lead to an exacerbation of proteinuria [ 55 ] and are an important risk factor for relapses [ 1 , 56 , 57 ].…”

Increased number and activation of peripheral basophils in adult‐onset minimal change disease

“…The biological functions of basophils are dependent on cell activation, which can be mediated by multiple stimulators, including IgE 31,32 . Serum IgE levels are increased in patients with MCD and then recovered to normal levels after remission 14,15,33 . In contrast, pathological examination of the kidneys in patients with MCD showed no deposition of IgE or IgE‐circulating immune complexes (CIC), indicating that IgE was an intermediate factor in MCD onset.…”

“…IgE and basophils maybe involved in the pathogenesis of MCD, 14,18 and Th cells may lead to the onset of MCD by up-regulating Th2 cells, which express high levels of Th2 cytokines, including IL-4 and IL-13. [7][8][9][10][11][12]24 Also, basophils are the dominant cell type producing Th2 cytokines in the early phase of Th2 response.…”

“…levels of IL-4 and IL-13 can participate in the onset of MCD. [7][8][9][10][11][12] Importantly, patients with MCD have low serum IgG levels 13 and elevated IgE levels, 14,15 suggesting that humoural immunity is involved in the onset of MCD. The onset of MCD is related to circulating immune factors 16 and proteinuria induced by podocyte dysfunction and podocyte injury 17 ; however, other mechanisms may also be involved in the pathogenesis of MCD, and the pathogenic factors involved in these mechanisms have not yet been identified.…”

The expression of respiratory tract virus in pediatric glomerular disease: a retrospective study of 45 renal biopsy in China

“…There have been some studies associating enteroviruses, Epstein-Barr virus (EBV), and cytomegalovirus (CMV) to nephropathy [5][6][7]. Infection, especially respiratory tract infection, is believed to be one of the risk factors for the onset, relapse, exacerbations, and development of end-stage renal disease (ESRD) in both adults and children with NS [8][9][10][11]. Previous studies have demonstrated that the respiratory syncytial virus (RSV), the most common respiratory virus, and its antibody were found in the urine, serum, epithelial cells of the respiratory tract, and peripheral blood mononuclear cells (PBMC) of patients with steroid-responsive nephrotic syndrome [12,13], and a small percentage of intranasal inoculation of RSV can cause nephropathy in rats [14].…”