The Effect Of Epstein Barr Virus Infection To Response To Steroids And Replase Of Children Primary Nephrotic Syndrome

Objective In China, primary nephrotic syndrome(PNS) is the common glomerular disease in childhood. The incidence rate of nephrotic syndrome is 16 cases per 100000 children every year. Epstein Barr virus(EBV) is a ubiquitous herpes virus, which widespread in mankind, persisting for the lifetime once infection. More than 90% of adults have seropositive antibody to Epstein Barr virus. Epstein Barr virus is transmitted via saliva, blood and solid organ nephrotic syndrome. Epstein Barr virus infection effects T and B cells immune function disorder, and primary nephrotic syndrome always coincidencn with Epstein Barr virus infection. The impact of Epstein Barr virus infection to the response to glueocorticosteroid(GC) and the relapse of primary nephrotic syndrome is still unknown. This observational study was aimed to study the prevalence of Epstein Barr virus infection in nephrotic syndrome and to evaluate the association of the Epstein Barr virus status and the relapses of primary nephrotic syndrome.Method A retrospective analysis was conducted in 650 patients diagnosed with childhood primary nephrotic syndrome. we used the real time fluorescent quantitation polymerase chain reaction assay to quantify the amount of EBV DNA in peripheral blood mononuclear cells in whole blood of all these patients. Statistics was used to analyse the prevalence of Epstein Barr virus in primary nephrotic syndrome. We compared the initial response to GC in chidren with simple primary nephrotic syndrome of the group of Epstein Barr virus infection within 4 weeks and 8 weeks to the group of none Epstein Barr virus infection when they were comparable. We also compared the incidence of patients with frequently relpase or steroid dependency(FR/SDNS) with simple type steroid sensitivitive nephrotic syndrome of Epstein Barr virus infection(group of Epstein Barr virus infection) during one year to the none Epstein Barr virus infection. Data processing used the SPSS 19.0 statistical software package, p < 0.05 as the significant standard test.Result 1.The prevalence of Epstein Barr virus infection in primary nephrotic syndrome was 45.08%(293/650); The highest positive rate of Epstein Barr virus infection(60.25%) was found in aged 10months~2 years; There was no diference of prevalence of Epstein Barr virus infection among different seasons of the year. 2. Of101 cases simultaneously with Epstein Barr virus infection in children with simple type primary nephrotic syndrome onset, after administered adequate glueocorticosteroid, 95 cases’ urine protein became negative within four weeks and the proportion was 89.62%; 97 cases’ urine protein became negative within eight weeks, and the proportion was 91.51%;Of 107 cases none Epstein Barr virus infection in children with simple type primary nephrotic syndrome onset, after administered adequate glueocorticosteroid, 99 cases’ urine protein became negative within four weeks and the proportion was 92.52%; 102 cases’ urine protein became negative within eight weeks and the proportion was 92.52%. The difference between the two groups was not statistical significant(p > 0.05). 3. The incidence of patients with frequently relapse or steroid dependency with steroid sensitivitive nephrotic syndrome of Epstein Barr virus infection during one year was 15.5%(11/71) in one year; the incidence of patients with frequently relapse or steroid dependency with steroid sensitivitive nephrotic syndrome of none Epstein Barr virus infection was15.7%(14/89) in one year. The differences between the two groups was not statistically significant(p > 0.05).Conclusion This retrospective study showed that although the prevalence of Epstein Barr virus infection of this study is higher than healthy population, Epstein Barr virus infection does not affect the response to steroids in children with simple type primary nephrotic syndrome and does not affect the frequently relpase or steroid dependency in children with simple type steroid sensitivitive nephrotic syndrome. This conclusion remains need to be confirmed by multi center, prospective, randomized controlled trials.