Kidney Week

Abstract: FR-PO0939

Autoantibodies Targeting Nephrin and CRB2 in Children with Nephrotic Syndrome

Session Information

• Pediatric Nephrology: Genetic Diseases, Development, Neonatal Nephrology, Glomerular Diseases, and More
  October 23, 2026 | Location: Exhibit Hall A, Convention Center
  Abstract Time: 10:00 AM - 12:00 PM

Category: Pediatric Nephrology

• 1800 Pediatric Nephrology

Authors

• Robinson, Cal, The Hospital for Sick Children, Toronto, Ontario, Canada

Cal Robinson, MBChB, PhD, FASN

• Leclerc, Simon, McGill University, Montreal, Quebec, Canada

Simon Leclerc, MD

• Aman, Nowrin F., The Hospital for Sick Children, Toronto, Ontario, Canada

Nowrin F. Aman, MBBS, MSc

• Aoudjit, Lamine, McGill University, Montreal, Quebec, Canada

Lamine Aoudjit

• Banh, Tonny Hue Minh, The Hospital for Sick Children, Toronto, Ontario, Canada

Tonny Hue Minh Banh

• Brooke, Josefina A., The Hospital for Sick Children, Toronto, Ontario, Canada

Josefina A. Brooke, RN

• Bruno, Valentina, The Hospital for Sick Children, Toronto, Ontario, Canada

Valentina Bruno, MD, MS, MSc

• Dhillon, Vaneet, The Hospital for Sick Children, Toronto, Ontario, Canada

Vaneet Dhillon, NP, RN

• Garner, Mackenzie Alexander, The Hospital for Sick Children, Toronto, Ontario, Canada

Mackenzie Alexander Garner

• Licht, Christoph, The Hospital for Sick Children, Toronto, Ontario, Canada

Christoph Licht, MD, FASN

• McKay, Ashlene Maree, The Hospital for Sick Children, Toronto, Ontario, Canada

Ashlene Maree McKay, MD

• Molinaro, Alessia Maria Carmela, McGill University, Montreal, Quebec, Canada

Alessia Maria Carmela Molinaro

• Noone, Damien Gerard, University of Alberta, Edmonton, Alberta, Canada

Damien Gerard Noone, MD, MSc

• Pearl, Rachel Jane, The Hospital for Sick Children, Toronto, Ontario, Canada

Rachel Jane Pearl, MD

• Radhakrishnan, Seetha, The Hospital for Sick Children, Toronto, Ontario, Canada

Seetha Radhakrishnan, MD

• Selvathesan, Nithiakishna, The Hospital for Sick Children, Toronto, Ontario, Canada

Nithiakishna Selvathesan, MD, MBChB

• Teoh, Chia Wei, The Hospital for Sick Children, Toronto, Ontario, Canada

Chia Wei Teoh, MBChB, MSc

• Vanos Hosick, Kristen, The Hospital for Sick Children, Toronto, Ontario, Canada

Kristen Vanos Hosick, RN

• Vasilevska-Ristovska, Jovanka, The Hospital for Sick Children, Toronto, Ontario, Canada

Jovanka Vasilevska-Ristovska, MD

• Takano, Tomoko, McGill University, Montreal, Quebec, Canada

Tomoko Takano, MD, PhD

• Weins, Astrid, Mass General Brigham Inc, Boston, Massachusetts, United States

Astrid Weins, MD, PhD, FASN

• Parekh, Rulan S., Women's College Hospital, Toronto, Ontario, Canada

Rulan S. Parekh, MD, MS, FASN

Background

Nephrotic syndrome is a common immune-mediated glomerular disorder among children. Autoantibodies targeting nephrin and CRB2 have been found among children and adults with nephrotic syndrome, although their pathophysiological role remains unclear. Our aims were to determine the prevalence of anti-nephrin and -CRB2 antibodies in childhood nephrotic syndrome and examine associations with outcomes and immunosuppression response.

Methods

We included children with primary nephrotic syndrome enrolled in a prospective Canadian cohort with specimens collected during relapse and remission. Anti-nephrin and -CRB2 antibodies were measured by ELISA. We evaluated associations between autoantibodies and steroid resistance, time-to-first relapse, frequent relapses or steroid dependence, relapse rate, and steroid-sparing immunosuppression response by regression analysis.

Results

Anti-nephrin and -CRB2 antibodies were measured in 298 samples from 149 children at median (IQR) 1.5 (0.5-4.5) years from nephrotic syndrome diagnosis. Anti-nephrin and -CRB2 antibodies were positive in 50 (33%) and 7 (5%) of relapse samples, respectively. Anti-nephrin and -CRB2 titers were significantly higher in relapse than remission (p<0.001). Positive anti-nephrin antibodies were more common in South, East, and Southeast Asian children (36-42%); those with frequent relapses or steroid dependence (42%); and minimal change disease (42%). Positive anti-CRB2 antibodies were more common in European children (7%) and those with focal segmental glomerulosclerosis (11%). There were no significant associations between anti-nephrin or -CRB2 antibody titer or positivity and time-to-first relapse or relapse rate (Table), or with sustained remission after initiating specific steroid-sparing immunosuppressive medications (all p>0.05).

Conclusion

Anti-nephrin and -CRB2 antibodies are found in less than one-third of children with nephrotic syndrome and titers correlate with relapses. Yet, we did not find evidence of associations with relapse rate or immunosuppression response. Thus, predictive utility in children remains uncertain.

Associations between autoantibodies and nephrotic syndrome relapses

Funding

• Government Support – Non-U.S.