Glucocorticoid Sensitivity in vitro can predict the Clinical Response to Steroid Therapy in Children with Idiopathic Nephrotic Syndrome

Mongia A, Bhangoo A, Ten S, Michl J and Ghanny S

Published on: 2022-02-26

Abstract

The use of steroids remains the mainstay of treatment in children presenting with Idiopathic Nephrotic Syndrome (INS).  10-20% of these patients may fail to respond to steroid treatment. Currently there are no validated diagnostic markers of steroid resistance in children with INS. Our objective was to study glucocorticoid sensitivity (GCS) in subjects with INS using an in vitro assay.

This was a Case Control study. All subjects and controls underwent GCS analysis in vitro using a fluorescein labeled-dexamethasone (F-DEX)-mononuclear cell (MNC)-binding assay. All 10 children underwent a standard course of steroid therapy.

The present study included 10 children (12 ± 4.5 yrs), 4 males and 6 females, with a clinical diagnosis of INS, who were being followed at the Children’s Kidney Center at SUNY Downstate Health Science University, Brooklyn, NY. We also compared these patients to 31 controls.

Three of 10 patients with INS were found to be glucocorticoid (GC) resistant with a GCSI of 223.6 ± 27; 3 patients had normal sensitivity with a GCSI of 343.5 ± 36.8 and 4 had increased sensitivity with a GCSI of 484.5 ±52.8. Significant improvement in serum albumin, total cholesterol and urinary protein/creatinine ratio after treatment was seen in all patients except the GC resistant group. GCSI positively correlated with the difference in albumin and negatively with the difference in urinary Protein/Creatinine ratio.

GCSI obtained by the F-Dex assay correlated with response to therapy in cases of INS.  This can help clinicians choose the appropriate treatment for these patients, while avoiding side effects of steroids.