Depression of local graft-versus-host reaction in patients with lipoid nephrosis

The local graft-versus-host reaction (GVHR) following intradermal injection of peripheral blood lymphocytes (PBL) in Lewis rats was examined in order to test the cell-mediated immunity (CMI) in 31 patients with renal disease and in healthy controls. It was found that patients with lipoid nephrosis (LN) in the nephrotic stage and systemic lupus erythematosus (SLE) had less mean lesion of the local GVHR and a smaller proportion with positive reactions as compared to normal subjects. This abnormality in LN patients was correlated well with the degree of delayed hypersensitivity skin test responses to purified protein derivative (PPD) and improved with the onset of clinical remission. In contrast, the mean lesion in PBL from LN patients without nephrotic syndrome (NS) and from chronic mesangial proliferative glomerulonephritis (CGN) did not differ from the normal subjects. These findings raise the question of a selective defect in CMI in LN patients with NS. Our studies also indicate that the local GVHR represents a rapid, clinically useful test for assessing cellular immunocompetence in renal disease.