Detection And Significance Of Cytokine In Children With Henoch-Schonle Nephritis In Serum, Urine And Renal Tissues

BackgroundHenoch-Schonlein purpura(HSP)is a common immune complex-induced systemic vasculitis in children,the vessel wall increased permeability by immune injury,exudation of blood and lymph,thus giving rise to multiple lesions such as skin,mucous membrane and viscera organs.High incidence rate and recurrent attacks of this disease,which are easy to affect the kidneys and lead to Henoch-Schonlein purpura nephritis(HSPN).HSPN is the major cause lead to chronic renal insufficiency.The exact pathogenesis of HSP and HSPN are not fully identified.At present,studies have shown that the occurrence,development and the sequential process of glomerular sclerosis in HSP/HSPN are closely related to cytokines.Interleukin(IL)-4,IL-6,IL-8,IL-13,IL-13 receptora2,tumor necrosis factor-a(TNF-α),and its have definitely correlation with the occurrence and development of HSP/HSPN.The study of cytokines is mostly limited to blood or urine detection at present,there is no renal biopsy tissues measured,and there was no reported about the expression of IL-13 in renal tissue with HSPN children.In this study,ELISA was used for examining the serum and the urine levels of IL-4,IL-6,IL-8,IL-13,IL-13 receptorα2, TNF-αwith HSP/HSPN;The expression of IL-13 and TNF-αin renal tissue with HSPN were detected by immunohistochemistry.The pathology in the kidney injury and its clinical significance was analyzed.The expression of cytokines in serum,urine and renal tissue were observed;And its role in the pathogenesis of HSP/HSPN was investigated.ObjectiveTo study the expression and clinical significance of IL-4,IL-6,IL-8,IL-13 receptorα2,TNF-αin serum and urine with HSP;to explore the changes of IL-13 and TNF-αwith HSPN in serum,urine and its relationship with the expression in renal tissue,kidney damage and clinical manifestations;to explore the role of IL-13 and TNF-αin the pathogenesis of HSPN so as to provide a new theory for prevention and cure in HSPN.MethodsTo examine the serum and the urine levels of IL-4,IL-6,IL-8,IL-13 receptora2,TNF-αof 113 children with HSP and 45 healthy children were examined by ELISA,and examine the serum and the urine levels of IL-13 of 29 children with HSPN by kidney biopsy and 25 healthy children were examined by ELISA also,compare the differences of the levels of cytokines between children in each group above and in healthy children.The expression of IL-13 and TNF-αof 29 children with HSPN and 3 healthy children were detected by immunohistoch-emistry,and analyze the levels of IL-13,TNF-αin serum,urine,kidney tissues and the relation with the pathology in the kidney injury and its clinical significance.Results1.The levels of IL-4,IL-6,IL-8,IL-13 receptorα2,TNF-αand in serum with HSP were higher than those in the healthy control group(P<0.01);the levels of IL-6,TNF-αin urine with HSP were higher than those in the healthy control group(P<0.05).2.The levels of IL-4,IL-6,IL-8,IL-13 receptorα2,TNF-αin serum with kidney damage group were higher than those in healthy control group;The levels of IL-6,IL-13 receptorα2,TNF-αin urine with kidney damage group were higher than those in healthy control group;The levels of TNF-αin serum and urine with kidney damage were higher than those of non kidney damage group;The levels of IL-13 and TNF-αin serum and urine with HSPN by kidney biopsy were higher than those of healthy control group.3.The glomerular expression of strength in IL-13 in different pathological grades had no significant difference between control group and in HSPN children with renal tissue(Ⅰ-Ⅳclass:P＞0.05,Vclass:P＜0.05),the expression of renal tubular was at higher intensity compare with the control group(P＜0.01); with the increase of pathological grade,the intensity of TNF-αat glomerular and tubulointerstitial region were higher than the control group(P<0.01).4.IL-13,TNF-αexpression levels in the kidney had closely related to clinical type,pathological type,urinary protein excretion in the characteristics of HSPN.5.The concentration of IL-13 in serum had no correlation with renal tissue expression of IL-13.The concentration of TNF-αin serum and its expression level of renal tissue was mildly relevant.Urinary TNF-a and IL-13 concentration was closely relevant with renal tissues.Conclusion1.IL-4,IL-6,IL-8,IL-13,IL-13 receptorα2,TNF-αplay an important role in the pathogenesis of HSP/HSPN,the determination of IL-6,IL-13,IL-13Rα2,TNF-αin the serum and urine are better reflect the incidence of HSP/HSPN.2.The high expression of IL-13 and TNF-αin renal tissues have involved in the pathogenesis of HSPN and played a role in the renal injury with HSP.3.IL-13,TNF-αexpression levels in the kidney have closely related to clinical type,pathological type,urinary protein excretion.This will be used to help to diagnose the Henoch-Schonlein purpura nephritis and evaluate the extent of damage in renal pathology.4.The detection of Urinary IL-13 and TNF-αcan assess the severity of renal injury indirectly and assist the diagnosis of renal pathological,clinical programs can be used as the basis for the development of one in the absence of renal pathology results.