SERUM AND URINARY SOLUBLE TUMOR-NECROSIS-FACTOR RECEPTORS IN PATIENTSWITH GLOMERULAR-DISEASES - CORRELATION WITH DISEASE SEVERITY AND PROGNOSIS

Two kinds of soluble tumor necrosis factor receptors-p55 sTNFR and p75 sTNFR-derived from the cell surface are generated during inflammation or immune reaction. In this work, we investigated the participation a nd prognostic significance of STNFRs in various glomerular diseases by using the EIA method to measure p55 sTNFR and p75 sTNFR concentration s in the sera and urine of patients with initial clinical manifestatio ns of glomerulopathy. The first phase of this study included 32 patien ts with minimal change disease (MCD, n = 7), focal glomerulonephritis (FS, n = 1), mesangial proliferative glomerulonephritis (MesGN, n = 4) , membranous glomerulopathy (MN, n = 5), IgA nephropathy (IgAN, n = 3) , chronic glomerulonephritis (CGN, n = 1), lupus nephritis (LN, n = 8) , and diabetic nephropathy (DMN, n = 2); 1 patient refused renal biops y: Our results indicated a significant increase of STNFR concentration s in the sera and urine of patients with FS, MeGN, CGN, and LN, but a minimal increase in patients with MCD of IgAN. The increased sTNFR lev els correlated well with kidney survival and many clinical parameters except hematuria. The sTNFR levels also correlated with the extent of tubular atrophy better than did glomerular cellularity in histology. I n the second phase, sequential studies were performed in 10 patients w ith LN (n = 6), IgAN (n = 2), MCD (n = 1), and MN (n = 1) after 1 and 6 months of therapy. Those results demonstrated that changes in urinar y p55 sTNFR concentrations may reflect the short-term response to ther apy (p = 0.02). Our data suggest that sTNFRs are involved in different ways with some selected, but not all, glomerular diseases. Serum and urinary sTNFRs can function as useful tools in monitoring clinical sev erity, as well as predicting kidney survival in LN, MesGN, and possibl y, FS.