Steroid-responsive and nephrotic syndrome and allergy: clinical studies.

Abstract

MMARY Eighty-four children with steroid-responsive nephrotic syndrome who had been shown to have, or were believed to have, minimal change histology were investigated to study the relationship between steroid-responsive nephrotic syndrome and allergy. They were found to have a greater incidence of the standard atopic disorders-asthma, eczema, recurrent urticaria, and hay fever. Their 1st-degree relatives had an increased incidence of these atopic disorders too. A nasal discharge was a frequent precursor or an accompaniment of nephrotic syndrome, but an overt atopic disorder at the same time was rare. Such disorders, related to relapse, occurred in only 5 children; in none was it a consistent or recurrent happening at the time of each relapse. No example of pollen hypersensitivity nephrotic syndrome was found, and no particular allergen could be identified with certainty as responsible for a child's nephrotic syndrome. No association was found between the time of relapse and the season of the year, or the season in which the child was born. Children with nephrotic syndrome had a greater incidence of positive skin tests to common antigens, the comparative frequency of positive reactions to different antigens being similar to that found in children with asthma, although the total frequency was about half that of children with asthma. Despite the increased incidence of clinical features of atopy, measures to reduce the frequency of relapse of nephrotic syndrome by allergen avoidance, the use of disodium cromoglycate, and the use of a new oral antiallergic drug were unsuccessful.

Cell Biology of the Glomerular Podocyte

“…Development of nephrotic syndrome may also follow allergic reactions in some cases (274). In atopy, Th2-mediated inflammation plays a central role.…”

Increased IL-2, IL-4 and interferon-gamma (IFN-γ) in steroid-sensitive nephrotic syndrome

“…Experimental data suggest that proteinuria in SSNS is mediated by a circulating factor(s) produced either by activated peripheral blood mononuclear cells (PBMC) or T lymphocytes [8][9][10][11]. Further evidence of an immune pathogenesis of SSNS arises from the clinical response to immunosuppressive treatment, and the increased incidence of atopy in affected children [12,13].…”

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).…”