The Correlation of Regulatory T (TReg) and Vitamin D3 in Pediatric Nephrotic Syndrome

Yunika Nurtyas


Nephrotic syndrome (NS) is an autoimmune disease that correlates to the imbalance of regulatory T cells (TReg). This study was aimed to investigate the effect of vitamin D as adjuvant therapy of TReg population in pediatric nephrotic syndrome. This study was designed randomized clinical trial, double blind, with pre- and post-test control groups involving 15 subjects newly diagnosed with NS. Subjects were divided into 2 groups, namely K1 for group treated with prednisone+vitamin D and K2 group for prednisone treatment only. The population of TReg in peripheral blood mononuclear cells (PBMC) was analyzed using flowcytometry. Vitamin D serum level was measured through ELISA method. Results showed that there was a significant elevation of TReg (independent t-test, p = 0.010) in K1 group, which was higher than in K2 group. The Pearson test in the K1 group showed that vitamin D level was positively correlated with TReg (p = 0.039, r = 0.779).


Nephrotic syndrome, vitamin D, TReg

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Bagga A (2008) Management of steroid sensitive nephrotic: revised guidelines. Indian Journal of Nephrology 18 (1): 31 – 39. doi: 10.4103/0971-4065.41289.

Zhang S, Audard V, Fan Q et al. (2011) Immunopathogenesis of idiopathic nephrotic syndrome. In: Hererra GA (ed) Experimental models for renal diseases: Pathogenesis and diagnosis. Basel, Karger. pp 94 – 106. doi: 10.1159/000313 947.

UKK Nefrologi Ikatan Dokter Anak Indonesia (2008) Tatalaksana sindrom nefrotik idiopatik pada anak. Jakarta, Badan Penerbit Ikatan Dokter Anak Indonesia.

Hafez MA, Shimada M, Lee PY et al. (2009) Idiopathic nephrotic syndrome and atopy: Is there a common link?. American Journal of Kidney Disease 54 (5): 945 – 953. doi: 10.1053/j.ajkd.2009.03.019.

Wang L, Li Q, Wang L et al. (2013) The role of Th17/IL-17 in the pathogenesis of primary nephrotic syndrome in chil-dren. Kidney and Blood Pressure Research 37 (1): 332 – 345. doi: 10.1159/000350161.

Wang (2008) Regulatory T cells in renal disease. International Journal of Clinical and Experimental Medicine 1 (4): 294 – 304.

Pereira WF, Brito-Melo GEA, Guimaraes FTL et al. (2014) The role of the immune system in idiopathic nephrotic syndrome: A review of clinical and experimental studies. Inflammation Research 63 (1): 1 – 12. doi: 10.1007/s00011-013-0672-6.

Terrier B, Derian N, Schoindre Y et al. (2012) Restoration of regulatory and effector T cell balance and B cell homeo-stasis in systemic lupus erythematosus patients through vitamin D supplementation. Arthritis Research and Therapy 14 (1): 1 – 10. doi: 10.1186/ar4060.

Urry Z, Chambers ES, Xystrakis E et al. (2012) The role of 1α,25 dihydroxyvitamin D3 and cytokines in the promotion of distinct Foxp3+and IL-10+ CD4+ T cells. European Journal of Immunology 42 (10): 2697 – 2708. doi: 10.1002/eji.2012 42370.

van den Berg JG, Weening JJ (2004) Role of the immune system in pathogenesis of idiopathic nephrotic syndrome. Clinical Science 107 (2): 125 – 136. doi: 10.1042/CS20040095.

Septarini AD, Tambunan T, Amalia P (2012) Calcium and vitamin D supplementation in children with frequently relapsing and steroid-dependent nephrotic syndrome. Paedi-atrica Indonesiana 52 (1): 16 – 21. doi: 10.14238/pi52.1.2012.16-21.

Esmaeeili M, Azarfar A, Hoseinalizadeh S (2015) Calcium and vitamin D metabolism in pediatric nephrotic syndrome: An update on the existing literature. International Journal of Pediatrics 15 (3): 103 – 109. doi: 10.22038/IJP.2015.3932.

Ginanjar E, Sumariyono, Setiati S, Setiyohadi B (2007) Vitamin D and autoimmune disease. Acta Medica Indone-siana 39 (3): 133 – 141.

Weng FL, Schults J, Heskovitz RM et al. (2005) Vitamin D insufficiency in steroid-sensitive nephrotic syndrome in remission. Pediatric Nephrology 20 (1): 56 – 63. doi: 10.1007/s00467-004-1694-7.

Araya C, Diaz L, Wasserfall C et al. (2009) T regulatory cell function in idiopathic minimal lesion nephrotic syndrome. Pediatric Nephrology 24 (9): 1691 – 1698. doi: 10.1007/s00467-009-1214-x.

Liu LL, Qin Y, Cai JF et al. (2011) Th17/ Treg imbalance in adult patients with minimal change nephrotic syndrome. Clinical Immunology 139 (3): 314 – 320. doi: 10.1016/ j.clim.2011.02.018.

Shao XS, Yang XQ, Zhao XD et al. (2009) The prevalence of Th17 cells and FOXP3 regulatory T cells (Treg) in chil-dren with primary nephrotic syndrome. Pediatric Nephrol-ogy 24 (1): 1683 – 1690. doi: 10.1007/s00467-009-1194-x.

Lang CL, Wang MH, Chiang CK, Lu KC (2014) Vitamin D and the Immune system from the nephrologist’s viewpoint. ISRN Endocrinology 14 (1): 1 – 11. doi: 10.1155/2014/ 105456.

Smolders J, Thewissen M, Peelen E et al. (2009) Vitamin D status is positively correlated with regulatory T cell function in patients with multiple sclerosis. PLoS ONE 4 (8): 63 – 45. doi: 10.1371/journal.pone.0006635.

Chambers ES, Suwannasaen D, Mann EH et al. (2014) 1,25-dihydroxyvitamin D3 in combination with transforming growth factor-β increases the frequency of Foxp3+ regulato-ry T cells through preferential expansion and usage of inter-leukin-2. Immunology 143 (1): 52 – 60. doi: 10.1371/journal.pone.0006635.

Gordillo R, Spitzer A (2009) The nephrotic syndrome. Pediatric in Review 30 (3): 94 – 104. doi: 10.1371/journal.pone.0006635.

Franchimont D (2004) Overview of the actions of glucocorticoids on the immune response: a good model to characterize new pathways of immunosuppression for new treatment strategies. Annals of the New York Academy of Sciences 1024 (1): 124 – 137. doi: 10.1196/annals.1321.009.

Heine G, Niesner U, Chang HD et al. (2008) 1,25-dihydroxyvitamin D3 promotes IL-10 production in human B cells. European Journal of Immunology 38 (8): 2210 – 2218. doi: 10.1002/eji.200838216.

Barrat FJ, Cua DJ, Boonstra A et al. (2002) In vitro generation of interleukin-10-producing regulatory CD4+ cells is induced by immunosuppressive drugs and inhibited by T helper type 1 (Th1)- and Th2-inducing cytokines. Journal of Experimental Medicine 195 (5): 603 – 616. doi: 10.1084/jem.20011629.

Zhou L, Lopes JE, Chong MMW et al. (2008) TGF-β-induced Foxp3 inhibits TH17 cell differentiation by antago-nizing RORγt function. Nature 453 (1): 236 – 240. doi: 10.1038/nature06878.


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