Authors

Pediatric Nephrology Research Center, Research Institute for Children's Health, Shahid Beheshti University of Medical Sciences, Tehran, Iran

Abstract

Background: Nephrotic syndrome (NS) is the most common pediatric chronic kidney disease characterized by massive proteinuria, hypoalbuminemia, edema, and hyperlipidemia. Corticosteroids, as the mainstay of treatment, resolve symptoms in most patients. However, some patients experience a relapsing-remitting course. Currently, there is no specific biomarker for the prediction of steroid response in patients with NS. The neutrophil/lymphocyte ratio (NLR) and platelet/lymphocyte ratio (PLR) are inexpensive, readily accessible parameters that are proved to be related to the inflammatory state in many disorders.
Method: We evaluated NLR and PLR ratios before and after steroid therapy in 50 pediatric patients with NS in a single pediatric referral center. Data analysis was carried out using SPSS software and the significance level was considered as 0.05.
Results: Medical response to steroid was compatible with steroid-dependent (SD) nephrotic syndrome (NS) in 30% (n=15), steroid-resistant (SR) NS in 12% (n=6), steroid-sensitive (SS) NS in 36% (n=18), and frequently relapsing (FR) NS in 22% (n=11). Fourteen patients (29.2%) did not experience recurrence. Before and after steroid therapy, the mean PLRs were 10.9 and 11.7 and the mean NLRs were 1.9 and 2.2, respectively, which were not statistically different (P>0.05).
Conclusion: We do not recommend NLR and PLR as predictors of steroid response in pediatric patients with NS.

Keywords

  1. Tapia C, Bashir K. Nephrotic Syndrome. StatPearls. Treasure Island (FL): StatPearls Publishing Copyright © 2021, StatPearls Publishing LLC; 2021.
  2. Trautmann A, Vivarelli M, Samuel S, Gipson D, Sinha A, Schaefer F, Hui NK, Boyer O, Saleem MA, Feltran L, Müller-Deile J, Becker JU, Cano F, Xu H, Lim YN, Smoyer W, Anochie I, Nakanishi K, Hodson E, Haffner D, International Pediatric Nephrology Association. IPNA clinical practice recommendations for the diagnosis and management of children with steroid-resistant nephrotic syndrome. Pediatric nephrology (Berlin, Germany). 2020; 35(8):1529-61.
  3. Larkins N, Kim S, Craig J, Hodson E. Steroid-sensitive nephrotic syndrome: an evidence-based update of immunosuppressive treatment in children. Archives of disease in childhood. 2016; 101(4):404-8.
  4. Colucci M, Carsetti R, Cascioli S, Serafinelli J, Emma F, Vivarelli M. B cell phenotype in pediatric idiopathic nephrotic syndrome. Pediatric nephrology (Berlin, Germany). 2019; 34(1):177-81.
  5. Mishra K, Kanwal SK, Sajjan SV, Bhaskar V, Rath B. Predictors of poor outcome in children with steroid sensitive nephrotic syndrome. Nefrologia. 2018; 38(4):420-4.
  6. Trautmann A, Schnaidt S, Lipska-Ziętkiewicz BS, Bodria M, Ozaltin F, Emma F, Anarat A, Melk A, Azocar M, Oh J, Saeed B, Gheisari A, Caliskan S, Gellermann J, Higuita LMS, Jankauskiene A, Drozdz D, Mir S, Balat A, Szczepanska M, Paripovic D, Zurowska A, Bogdanovic R, Yilmaz A, Ranchin B, Baskin E, Erdogan O, Remuzzi G, Firszt-Adamczyk A, Kuzma-Mroczkowska E, Litwin M, Murer L, Tkaczyk M, Jardim H, Wasilewska A, Printza N, Fidan K, Simkova E, Borzecka H, Staude H, Hees K, Schaefer F, Consortium P. Long-Term Outcome of Steroid-Resistant Nephrotic Syndrome in Children. Journal of the American Society of Nephrology: JASN. 2017; 28(10):3055-65.
  7. Franke I, Aydin M, Kurylowicz L, Lopez CEL, Ganschow R, Lentze MJ, Born M. Clinical course & management of childhood nephrotic syndrome in Germany: a large epidemiological ESPED study. BMC nephrology. 2019; 20(1):45.
  8. Liu J, Liu X, Li Y, Quan J, Wei S, An S, Yang R, Liu J. The association of neutrophil to lymphocyte ratio, mean platelet volume, and platelet distribution width with diabetic retinopathy and nephropathy: a meta-analysis. Bioscience reports. 2018; 38(3).
  9. Nickavar A, Valavi E, Safaeian B, Amoori P, Moosavian M. Predictive Value of Serum Interleukins in Children with Idiopathic Nephrotic Syndrome. Iranian journal of allergy, asthma, and immunology. 2020; 19(6):632-9.
  10. Roca N, Martinez C, Jatem E, Madrid A, Lopez M, Segarra A. Activation of the acute inflammatory phase response in idiopathic nephrotic syndrome: association with clinicopathological phenotypes and with response to corticosteroids. Clinical kidney journal. 2021; 14(4):1207-15.
  11. Polak D, Borovitz Y, Clyman-Levy D, Klein Y, Bernfeld N, Davidovits M, Davidovich E. Salivary Cytokines in Children with Nephrotic Syndrome versus Healthy Children: A Comparative Study. Journal of clinical medicine. 2020; 9(9).
  12. Adamstein NH, Ridker PM. The neutrophil-lymphocyte ratio: considerations for clinical application. European heart journal. 2021; 42(22):2216-7.
  13. Tsai SF, Wu MJ, Chen CH. Low serum C3 level, high neutrophil-lymphocyte-ratio, and high platelet-lymphocyte-ratio all predicted poor long-term renal survival in biopsy-confirmed idiopathic membranous nephropathy. Scientific reports. 2019; 9(1):6209.
  14. Wadgaonkar Udit Rajendra NR, Sethu Prabhu Shankar. A Study of Neutrophil/Lymphocyte Ratio in Chronic Kidney Disease. Journal of Evidence Based Medicine and Healthcare. 2020; 7(24):1149-53.
  15. Fonseca JA, Gameiro J, Duarte I, Jorge S, Lopes JA. The neutrophil-to-lymphocyte ratio as a marker of vasculitis activity, severe infection and mortality in anca-associated vasculitis: A retrospective study. Nefrologia. 2021; 41(3):321-8.
  16. Binnetoğlu E, Şengül E, Halhallı G, Dindar S, Şen H. Is neutrophil lymphocyte ratio an indicator for proteinuria in chronic kidney disease? Journal of clinical laboratory analysis. 2014; 28(6):487-92.
  17. Gnanamoorthy Kothai KN, Aruna Bholenath Patil, Athanallur Raman Malathy, Suthakaran Prasanna Karthik Neutrophil Lymphocyte Ratio as a Marker of Diabetic Nephropathy Journal of Evidence Based Medicine and Healthcare. 2020; 7(26).
  18. Toraman A, Neşe N, Özyurt BC, Kürşat S. Association between neutrophil-lymphocyte & platelet lymphocyte ratios with prognosis & mortality in rapidly progressive glomerulonephritis. The Indian journal of medical research. 2019; 150(4):399-406.