Oke Rina Ramayani *,Nanan Sekarwana ,Partini Pudjiastuti Trihono ,Ahmad Hamim Sadewa ,Aznan Lelo ,Putri Chairani Eyanoer
Background: Patients with steroid-resistant nephrotic syndrome (SRNS) tend to progress to end-stage renal disease (ESRD). Although the risk of steroid resistance depends mainly on histopathology, other factors, such as cytokines, may contribute to this condition. Cytokine macrophage Migration Inhibitory Factor (MIF) acts to counterregulate glucocorticoids, which have become the main drug therapy for NS. The aim of this study was to evaluate whether raised serum MIF levels represent a potential risk factor for SRNS patients.
Methods: A prospective study was conducted in a multi-centre hospital and school in Medan, Sumatera, Indonesia. A total of 99 subjects were included in the study consisting well child (n=31) and NS patients (n=68). Serum macrophage migration inhibitory factor (MIF) was collected and measured. Patient’s data about demographics, blood pressure, threshold steroid dosage at inclusion, urinary albumin creatinine ratio, plasma angiotensin II and serum MIF were compared between groups.
Results: Majority of subjects showed MIF levels between 10.4 and 31.8 ng/ml. Group SRNS had significantly higher serum MIF (median 31.9 (14.3-117.2) ng/mL) compared to the levels in group SSNS (median 21.8 (10.4-31.8) ng/mL) and well child (median 24.1 (11.4-31.1) ng/mL. Half of SRNS subjects (n=20) showed higher levels of MIF. In logistic regression analysis, diastolic blood pressure and plasma angiotensin II levels were found to be independently associated with higher serum MIF. There was a weak positive liniear correlation between concentration of MIF serum and angiotensin II plasma.
Conclusions: The serum MIF levels in group SRNS is higher than SSNS and well child. Diastolic blood pressure and plasma angiotensin II levels were found to be independently factors associated with higher MIF serum.
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