TUMOR NECROSIS FACTOR-µ
(TNF-µ) PRODUCTION
FROM CULTURED PERIPHERAL BLOOD MONONUCLEAR CELLS (PBMC) IN CHILDREN WITH
PRIMARY NEPHROTIC SYNDROME (PNS)
Bakr A, Shokeir M,
El-Chenawy F, El-Ashry R
Mansoura University
Children's Hospital, Mansoura, Egypt
Objective: To assess the role of TNF-µ in the pathogensis of PNS.
Methods: TNF-µ levels in supernatant fluid from cultured PBMC were measured by
ELISA in 55 children with PNS, 10 patients with minimal change nephrotic
syndrome (MCNS) in remission, and 10 healthy controls. Patients with active
PNS were 21 patients with steroid-sensitive (SS)-MCNS, 6 patients with
steroid�Cresistant (SR)-MCNS, 11 with SR-focal segmental glomerulosclerosis
(FSGS), 6 patients with SS-diffuse mesangial proliferation (DMP), 5 patients
with SR-DMP and 6 patients had mesangiocapillary glomerulonephritis (MCGN).
Results: Patients with PNS of any pathological
type had elevated TNF-a levels compared to controls. Patients with FSGS had the highest
TNF-a levels compared to
MCGN (P=0.015), DMP (P=0.006) and MCNS (P=0.002). TNF-a levels were elevated in MCNS�CSR patients compared to MCNS-SS
(P=0.019), while remission was associated with normalization of TNF-a levels. There was a positive correlation between TNF-a levels and the degree of proteinuria (r=0.34, P=0.013), degree of
mesangial hypercellularity (r=0.42, P=0.028) and degree of
glomerulosclerosis (r=0.46, P=0.001). By discriminate analysis, TNF-a levels at cut off point > 30 pg/ml, could be used to
predict resistance to steroid therapy (sensitivity 92.9%
specificity=93.2%). Moreover, TNF-a levels could be used to discriminate between patients with SR-MCNS,
SR-FSGS and SR-DMP (sensitivity & specificity=100%).
Conclusion: TNF-a from cultured PBMCs might be responsible for glomerular abnormalities
noticed in PNS of different pathological types. TNF-a levels in PBMC culture could be used to predict the pathological
type of PNS and the response of these patients to steroid therapy.