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Lymphocyte adenosine deaminase activity in children with idiopathic nephrotic syndrome
Om P Mishra1, Jayant Ghosh, Ziledar Ali
1Institute of Medical Sciences, Department of Pediatrics, Banaras Hindu University, Varanasi, India. opmpedia@yahoo.co.uk
Insights
Adenosine deaminase (ADA) activity is elevated in children with active nephrotic syndrome, particularly in relapsers. Levels normalize in long-term remission, indicating ADA
Area of Science:
- Immunology
- Pediatric Nephrology
- Biochemistry
Background:
- Cell-mediated immunity is crucial in idiopathic nephrotic syndrome (INS).
- Adenosine deaminase (ADA) is a key enzyme in lymphocyte proliferation and differentiation.
- Measuring ADA activity in serum and lymphocytes may offer insights into immune status in INS.
Purpose of the Study:
- To evaluate serum ADA (S-ADA) and lymphocyte ADA (L-ADA) activity in children with INS.
- To correlate ADA levels with disease activity, relapse frequency, and remission status.
- To assess ADA as a potential biomarker for immune dysregulation in pediatric nephrotic syndrome.
Main Methods:
- Adenosine deaminase activity was measured in serum and lymphocytes.
- Study included 47 children with idiopathic nephrotic syndrome and 23 healthy controls.
- Patients were categorized into active nephrotic syndrome, first attack, relapsers, frequent relapsers, and remission groups.
Main Results:
- Significantly elevated S-ADA and L-ADA levels were observed in active nephrotic syndrome compared to controls.
- ADA activity was highest in frequent relapsers and significantly higher in relapsers versus first-attack patients.
- S-ADA normalized in remission, while L-ADA remained elevated but normalized in long-term remission.
Conclusions:
- Adenosine deaminase activity is significantly altered in children with active nephrotic syndrome.
- Elevated ADA levels correlate with disease activity and relapse frequency, suggesting immune involvement.
- L-ADA may serve as a sensitive marker, showing changes even in the remission stage of INS.
Abstract:
Adenosine deaminase (ADA) activity, as a marker of cell-mediated immunity, was evaluated in the serum (S-ADA) and lymphocytes (L-ADA) of 47 children with idiopathic nephrotic syndrome, and 23 healthy controls. The mean S-ADA and L-ADA levels were significantly raised in active nephrotic syndrome (ANS) and in its sub-groups in comparison with controls. The ADA activity was significantly more elevated in relapsers than for the first attack of nephrotic patients, and the frequent relapsers had the highest enzymatic levels both in serum as well as lymphocytes. A significant positive correlation was found between serum and lymphocyte ADA levels (r =0.736, p <0.01). In remission, the S-ADA showed a significant fall in comparison with their corresponding ANS value (p <0.001) and reached the level of controls. The mean L-ADA also showed reduction but the difference was statistically insignificant and the value was significantly raised, when compared with controls. The enzyme activity in serum and lymphocytes normalized in the long-term remission group. Thus, ADA activity was abnormal in ANS cases, and L-ADA demonstrated change both in active as well as remission stage of the disease.
