Apoptotic Tendency in Nephrotic Syndrome and Acute Post Streptococcal Glomerulonephritis

ABSTRACT
Background: Renal diseases are in many cases associated with the presence of an increase number of apoptotic cells in the kidney and its potential role ranges from induction and progression to repair of renal injury. Objective: This study was designed to assess the level of the apoptotic marker anti-annexin  V IgG antibodies as an indicator of severity and a prognostic marker in both nephrotic syndrome (NS) and acute post streptococcal glomerulonephritis (APSG) patients. Methods: The current study included 50 children had adolescents. Twenty were diagnosed as NS and 15 of them were diagnosed as APSGN based on their full medical history Taking and relevant laboratory investigations. They were compared to 15 clinically healthy, age-and sex-matched children and adolescents as a control group. Each enrolled was subjected to detailed history taking and through clinical examination. Routine laboratory workup was done including full analysis, 24hour urinary protein, complete blood count, and serum protein, albumin, cholesterol, creatinine, blood urea nitrogen and complement (C3). Plasma anti-annexin V IgG was estimated for all patients and controls by ELISA technique. The patients were followed up until initial improvement than they were subjected to the previous clinical and laboratory evaluation. Results: There was significantly higher anti-annexin V IgG levels in NS and APSGN patients compared to the controls (P value are < 0.05 and < 0.01 respectively). There was also significant higher anti-annexin V IgG level in APSGN patients compared to NS patients before treatment (P<0.05). There was no significant difference between each studied group and the controls or between each other after treatment. Anti-annexin V IgG level showed that positive correlation with urinary protein and a negative correlation with serum albumin in NS patients and serum creatinine of APSGN patients showed positive correlation with the rate of change of anti-annexin V IgG, however, these correlation were of no statistical significance. Conclusions: From the present study we can conclude that anti-annexin V IgG antibodies can be used as a marker of renal affection indicating the severity of underlying pathology and it could be of prognostic value since its normalization couples the clinical improvement. Anti-annexin V IgG antibodies can be also used to differentiate between the underlying pathologies since it is significantly higher in patients with APSGN patients compared to NS patients further proving that apoptosis is the major cell clearance mechanism counterbalancing cell division, thereby mediating resolution of glomerular hypercellularity in APSGN.