Are uraemic children immunologically compromised?
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C Ensari1, M Ekim, A Ikinciogullari
1Nephrology and Dialysis Unit, Emergency Hospital, Ankara, Turkey.
Insights
Uraemic children show some immune variations but are not generally immunocompromised. Lymphocyte counts and immunoglobulin levels may be affected by end-stage renal disease treatments.
Area of Science:
- Pediatric Nephrology
- Immunology
- Renal Failure
Background:
- Uraemia in adults is linked to immune dysfunction.
- Limited data exists on immune status in pediatric uraemia.
Purpose of the Study:
- To evaluate immune status in children with end-stage renal failure.
- To compare immune parameters across different renal replacement therapies.
Main Methods:
- Assessed lymphocyte counts and subsets (CD3+, CD4+, CD8+, CD16+, CD20+).
- Performed skin tests (PPD, Candida) and measured serum immunoglobulins (IgG, IgA, IgM) and complement (C3, C4).
- Compared 30 children with end-stage renal failure (pre-dialysis, CAPD, HD) to 15 healthy controls.
Main Results:
- Significant lymphopenia observed in pre-dialysis and haemodialysis groups.
- Absolute lymphocyte subset counts were lower in all patient groups compared to controls.
- Decreased Candida skin test response in pre-dialysis; reduced immunoglobulin levels in CAPD patients.
Conclusions:
- Uraemic children exhibit some immune variations, not general immunocompromise.
- End-stage renal disease and its treatments can influence specific immune parameters in children.
Background:
Various immunological abnormalities leading to impaired immune status have been described in uraemic adults; however, few data are available for uraemic children.
Methods:
In this study, peripheral blood total lymphocyte count and lymphocyte subsets (CD3+, CD4+, CD8+, CD16+, CD20+) were evaluated, skin tests with PPD and Candida antigens were performed, and serum immunoglobulin (IgG, IgA, IgM) and complement (C3, C4) levels were measured in 30 children with end-stage renal failure (10 before dialysis, 10 on continuous ambulatory peritoneal dialysis, and 10 on haemodialysis) and the results compared with those of 15 healthy controls.
Results:
The data showed significant lymphopenia in predialysis and haemodialysis groups. No significant change was observed in the CD4+/CD8+ ratio or in the percentages of lymphocyte subsets in either group studied, while the absolute values of some lymphocyte subsets were significantly lower in all groups as compared with controls. In skin test evaluation, only the patients in the predialysis group showed a significantly decreased response to Candida antigen. The serum immunoglobulin levels were significantly decreased in the continuous ambulatory peritoneal dialysis group as compared with the control group.
Conclusion:
Our results, together with those of other paediatric studies, reported in the literature, suggest that uraemic children are not immunocompromised, though the effects of uraemia may cause some variation in their immune status.
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