ELEVATED URINARY NEOPTERIN - A CLUE OF ACTIVATED MACROPHAGE AND CELLULAR IMMUNE-RESPONSE IN THE PATHOGENESIS OF IDIOPATHIC NEPHROTIC SYNDROME

A study of cell mediated immunity (CMI) activation in patients with id iopathic nephrotic syndrome (INS) in the tropics was undertaken. Cell mediated immunity activation was investigated by measureing urinary ne opterin excretion. All 31 patients with idiopathic nephrotic syndrome due to either minimal change nephrotic syndrome (MCNS), and focal and segmental glomerulosclerosis (FSGS) had significant elevation of neopt erin excretion (mean values 451, 544 mu mol neopterin/mol creatinine) when compared with 222 normal subjects (mean value 130, P<P.001). Howe ver, in 25 patients with non-nephrotic IgA nephropathy and eight nephr otic membranous nephropathy the urinary neopterin was not raised (mean value 131 and 129). A further 10 patients with MCNS were restudied wh en in complete remission and their urinary neopterin was found to have decreased significantly (mean value 186); however, this level was sti ll above the normal range. Our study suggests that CMI and macrophage activation takes place in the pathogenesis of idiopathic nephrosis.