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Serum antibody response to pneumococcal vaccine in children with nephrotic syndrome
Insights
Children with nephrotic syndrome, especially steroid-resistant cases, show reduced pneumococcal antibody responses. Pneumococcal vaccination may offer protection for steroid-responsive patients, but corticosteroid use can impact efficacy.
Area of Science:
- Pediatric Nephrology
- Immunology
- Vaccinology
Background:
- Children with nephrotic syndrome are at increased risk of severe pneumococcal infections.
- Immunodeficiency may arise from impaired humoral immunity or immunoglobulin loss during relapse.
Purpose of the Study:
- To assess the immunogenicity of polyvalent pneumococcal vaccine in children with nephrotic syndrome.
- To compare antibody responses between steroid-responsive, steroid-resistant, and control groups.
Main Methods:
- 27 steroid-responsive, 6 steroid-resistant nephrotic patients, and 12 controls received pneumococcal vaccine.
- Antibody responders had >2-fold increase and >200 ngN/ml post-vaccination antibody levels.
Main Results:
- Steroid-resistant patients had significantly depressed antibody concentrations pre- and post-vaccination (P < .002).
- Steroid-responsive patients off corticosteroids showed higher antibody levels than controls (P < .05).
- Corticosteroid use in steroid-responsive patients was associated with lower antibody response to type 19F (P < .05).
Conclusions:
- Pneumococcal vaccine is immunogenic in children with steroid-responsive nephrotic syndrome.
- The vaccine may provide protection against vaccine-contained pneumococcal types in these patients.
- Steroid resistance and corticosteroid therapy impact vaccine response.
Abstract:
Children with nephrotic syndrome are susceptible to serious pneumococcal disease and may be immunodeficient on the basis of abnormal humoral immune responses to natural antigens or immunoglobulin loss during relapse. As part of an ongoing study to evaluate pneumococcal anticapsular antibody concentration and immunologic competence, 27 steroid-responsive and six steroid-resistant patients with nephrotic syndrome, and 12 age-matched control subjects, were vaccinated with polyvalent pneumococcal vaccine. Antibody responders were defined as patients with at least a twofold increase in antibody after vaccination as well as an antibody concentration greater than 200 ng of anticapsular antibody nitrogen per milliliter (ngN/ml) after vaccination. Pneumococcal antibody concentrations before and after vaccination were significantly depressed in steroid-resistant patients when compared with control subjects (P less than .002) and with the steroid-responsive nephrotic syndrome group (P less then .001). Steroid-responsive nephrotic children who were not receiving corticosteroid therapy at the time of vaccination had significantly higher antibody concentrations to five pneumococcal types before vaccination and to seven types after vaccination compared with control subjects (P less than .05). Fewer steroid-responsive patients receiving corticosteroids achieved antibody concentrations greater than or equal to 200 ngN/ml against type 19F compared with patients not receiving steroids or with control subjects (P less than .05). These results suggest that pneumococcal vaccine is immunogenic in children with steroid-responsive nephrotic syndrome and may protect these patients from disease due to pneumococcal types contained in the vaccine.