Steroid dependent minimal change nephrotic syndrome

However, a role for T cells cannot be dismissed because RTX may affect T-cell function. RTX has been effective in the treatment of rheumatoid arthritis, a classic T-cell-mediated disease. In patients with SLE, treatment with RTX results in a decrease in activated T cells [ 31 ], although the effect may be disease specific since no such changes were documented in patients with membranous nephropathy treated with RTX [ 32 ]. Furthermore, a small population of T cells do express CD20 [ 33 ]. Alterations in the nuclear factor kappa B (NF-kB) pathway of both CD4 T cells and non-CD4 mononuclear cells may be involved in the development of MCD [ 34 ]. RTX inhibits the constitutive NF-kB signaling pathway in B-cell lines, and it is possible that inhibition of this pathway may be beneficial in NS. B cells also play an important role in induction of inflammatory cytokines, antigen presentation to T cells, dendritic cells, and macrophages, T-cell activation and generation of ectopic lymphogenesis [ 35 ], and RTX may directly or indirectly alter T-cell function in patients with MCD. In fact, as Shalhoub [ 27 ] pointed out, ‘It is conceivable that the feedback control system governing the activity of helper and suppressor T cells depends to some extent on the concentration of specific immunoglobulin whose synthesis is affected by these cells. Consequently, if abnormalities of Ig synthesis can be demonstrated in lipoid nephrosis, the primary disturbance may involve B-cell dysfunction.’

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Steroid dependent minimal change nephrotic syndrome

steroid dependent minimal change nephrotic syndrome

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