Abstract
Dynamic changes of T lymphocyte subsets and serum immunoglobulin (Ig) E levels were studied in focal glomerular sclerosis (FGS ; 8 cases) and minimal change nephrotic syndrome (MCNS : 11 cases), Twenty-two healthy volunteers were served as a control group. T lymphocyte subsets were identified by the indirect immunof luorescence technique using monoclonal antibodies; OKT 3 (T 3 ; peripheral T), OKT 4 (T 4 ; helper inducer) and OKT 8 (T 8 ; suppressor/cytotoxic). Serum IgE was measured by the radioimmuno-sorbent assay. All patients were treated with prednisolone in a daily dose of 40 mg or 60 mg for 4 to 8 weeks, follow by maintenance dose of 10 to 20 mg a day for at least 2 years. Patients with FGS were clinically separated into 2 groups, according to clinical status in the fourth month after initiation of the steroid therapy. In group I, 4 patients who were responded to the therapy, resulting in disappearance of proteinuria were included, and 4 patients in group II failed to response, remaining in nephrotic state or incomplete remission (urinary protein excretion > 1.0 g/day) through the initial 4 months. In the nephrotic phase of FGS and MCNS, serum IgE levels were markedly elevated, but there was no significant change of T lymphocyte subsets. After administration of steroid, T 3, T 4, and T4/T8 ratio were decreased, and serum IgE returned to the normal range in group I. However, in group II, T3, T4 and T4/T8 ratio were increased, and serum IgE was decreased but still remained in a higher level. MCNS showed decreases in T 3, T 4, T 4/T 8 ratio and serum IgE and increase in T 8 after steroid therapy as observed in group I of FGS. This study clarified that FGS could be separated into two groups based on the clinical response to steroid therapy, and each groups might have individual response pattern of T lymphocyte subsets, suggesting an important role of the response pattern to determine a prognosis in patients with FGS.
