Effect of corticosteroid and vitamin D3 as combined therapy on 25 (OH) vitamin D serum level and regulatory T (TReg) cells population in children with idiopathic nephrotic syndrome

摘要

Background : Nephrotic syndrome (NS) is a chronic disease in children that correlates with T lymphocyte dysregulation (imbalance of regulatory T cells (T_(Reg))/ T-helper 17 (Th17) cells ratio). Vitamin D3 serum level was known decreased in children with nephrotic syndrome.? Low vitamin D3 serum level can affect the outcome of nephrotic syndrome management with corticosteroid therapy. This study was aimed to investigate the effect of vitamin D as adjuvant therapy to 25 (OH) Vitamin D serum level and T_(Reg) population in children with idiopathic nephrotic syndrome. Method: This study was designed as a randomized clinical trial, double-blind, pre and post-test control group which involved 30 subjects that newly diagnosed as NS. Subjects were divided into two groups, prednisone and vitamin D treated group and prednisone only treated group. T_(Reg) population in peripheral blood mononuclear cells (PBMC) was analyzed using flow cytometry. Vitamin D serum level was measured by ELISA method. Results: Results showed that there was a significant elevation of ?T_(Reg) (independent t-test, p=0.001) and 25 (OH) vitamin D serum level (independent t-test, p=0.001) in prednisone and vitamin D treated group as compared to prednisone only treated group. Pearson testing first group showed that vitamin D level was positively correlated with T_(Reg)(p=0.332, r = 0.183). The number of early remissions was higher in group treated with steroid and vitamin D3 as a combined therapy compared to group treated with steroid only (50 % vs 20%). Whereas the number of late remission was higher in steroid only group (23% vs 6%). Conclusions : We concluded that corticosteroid and vitamin D3 as a combined therapy increase both of T_(Reg)and 25 (OH) vitamin D level which affect glucocorticoid therapy response in subjects.The number of early remission was higher in group treated with corticosteroid and vitamin D3 as a combined therapy.