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Kidney Week

Abstract: SA-PO981

Prospective Study of B-Cell Subsets in New-Onset Primary Podocytopathy in Adults

Session Information

Category: Glomerular Diseases

  • 1403 Podocyte Biology

Authors

  • Bharati, Joyita, Post Graduate Institute of Medical Education and Research, Chandigarh, Chandigarh, India
  • Jhaveri, Kenar D., Donald and Barbara Zucker School of Medicine at Hofstra/Northwell, Hempstead, New York, United States
Background

Data on children suggests the involvement of an altered B-cell immunophenotype in the pathogenesis of nephrotic syndrome (NS) due to primary podocytopathy. Characterization of the immune signature in NS patients will likely improve therapeutic strategies. We examined B-cell subsets in a cohort of adults with new-onset NS.

Methods

This was a prospective study at a tertiary care center in India. Adults with new-onset NS due to biopsy-proven primary minimal change disease or focal segmental glomerulosclerosis were included. Three sequential visits for blood sampling were: 1(on the day of starting prednisolone), 2 (2 weeks after visit 1), and 3 (6 months after visit 1 and 2 weeks after stopping prednisolone). B-cell subsets studied were: naïve B cells (CD19+27-), memory B-cells (CD19+27+), and transitional B-cells (CD19+27-38+24+). Patients were categorized based on steroid responsiveness as steroid resistant (SR), infrequently relapsing NS, and steroid-dependent NS; the latter two were grouped as steroid sensitive (SS).

Results

Of 67 patients, 87% were steroid-sensitive (SS) within four weeks of therapy. The transitional B-cell proportion was lower, and the total B-cell proportion was higher in patients at baseline than 35 healthy controls. The baseline naive B-cell proportion was lower, and the memory B-cell proportion was higher in steroid-resistant (SR) patients than in steroid-sensitive (SS) patients (Table). The naive B-cell proportion decreased at the second visit and was followed by a plateau at the third visit (p=0.003). Memory B-cell proportion increased at the second visit, followed by a plateau at the third visit (p=0.005). Transitional B-cell proportion remained similar across all three visits (p=0.18).

Conclusion

Memory B-cell proportion was higher, and naïve B-cell proportion was lower in SR patients than in SS patients. While naive B-cells decreased, memory B-cells increased initially during prednisone treatment in the whole cohort.

Baseline B-cell percentage
 IFRNS (N=50)SDNS (N=8)SRNS (N=9)P value
Total B-cells, % of total lymphocytes18.2 (12.4-23.1)18.2 (12.4-23.1)11.4 (7.9-22.1)0.31
Naive B-cells, % of total B-cells83.5 (76.4-90.7)83.9 (74.3-93.9)72.8 (58.6-73.3)0.004
Memory B-cells, % of total B-cells15.6 (9-23.7)15.8 (6.1-25.9)27.5 (26.6-38.3)0.008
Transitional B-cells, % of naive B-cells3.8 (1.9-8.4)4.3 (2-14.9)6.5 (2.9-9.9)0.68

IFRNS: infrequently relapsing nephrotic syndrome, SDNS: steroid-dependent nephrotic syndrome, SRNS: steroid-resistant nephrotic syndrome

Funding

  • Government Support – Non-U.S.