Mediadores inflamatórios na síndrome nefrótica em crianças e adolescentes

Abstract

The pathogenesis of idiopathic nephrotic syndrome (INS) remains unknown. Several findings suggest a role for the immune system. This study aimed to evaluate the profile of circulating and urinary immune mediators in INS by measuring plasma and urinary levels of TGF-1, MCP-1/CCL2, RANTES/CCL5 and IL-8/CXCL8 in pediatric patientswith INS and in age-matched healthy controls. Patients were classified according to their response to treatment with corticosteroids: steroid-sensitive (SS, n = 12), or steroid-resistant (SR, n = 21); as well as according to their proteinuria levels: patients with < 200mg/24 hours (LP, n = 15), and > 200mg/24 hours (HP, n = 18). Immune mediators were measured by Elisa. Plasma TGF-1 levels in SR patients were approximately 3.7-fold higher than control values (p<0.05). Urinary IL-8/CXCL8 was 3.4-fold higher in HP group than in LP group (p<0.05), and its levels had a positive correlation with individual proteinuria values (p<0.05). No changes in MCP-1/CCL2 and RANTES/CCL5 levels were detected. Our findings suggest that both TGF-1 and IL-8/CXCL8 could be involved in the pathogenesis of INS, the first being related to theprogression of the disease and worse prognosis, and the latter associated with glomerular inflammation and local changes in permeability.