Low serum IgG level during remission: A predictor of frequent relapse nephrotic syndrome

Low serum IgG level during remission: A predictor of frequent relapse nephrotic syndrome

Farid Ahmed1, Sanjeev Kumar Prasad2, Shireen Afroz3, Kanta Chowdhury4, Maruf-ul-
Quader5, Mohammed Hanif6

Abstract
Background: In general decreased serum IgG level in a patient with active nephrotic
syndrome reverts back towards normal during remission. But literature revealed
that patients who turned out to be frequent relapse nephrotic syndrome, in them
serum IgG remains in the lower range during remission. Persistently low serum IgG
level during remission may be a predictor of frequent relapse nephrotic syndrome.
Objective: To determine serum IgG level in children with nephrotic syndrome and also
to see whether this IgG level has any relationship with frequent relapse nephrotic syndrome.
Materials and Methods: This prospective study was conducted between May 2003 to
April 2004 in the Nephrology unit of Dhaka Shishu (Children) Hospital. Total 30 children
of first attack of nephrotic syndrome, age ranging from 1 to 10 year were included in
this study. Patients of initial attack of nephrotic syndrome were treated with standard
dose of oral prednisolone according to ISKDC protocol. They were followed up for 1
year and during this follow up period they were diagnosed as infrequent relapse
nephrotic syndrome, frequent relapse nephrotic syndrome and non relapser. Serum
IgG was estimated on 3 occasion; at the onset of the disease, after 6 weeks when the
patient achieved remission & again when the patient had first relapse.
Results: Among 30 patients 20 were male and 10 were female (Male: female= 2:1).
The serum IgG level at the onset showed no significant relation with the rate of
relapse (p=0.634).Serum IgG level during relapse showed near to significant relation
with the rate of relapse though not statistically significant (p=0.051). During remission
mean serum IgG level in frequent relapsers was 5.57± 0.72 (gm/L), in infrequent
relapsers was 9.35 ± 3.13 (gm/L) and those patients who had no relapse was 9.51±
3.62 (gm/L). During remission, serum IgG level in frequent relapse nephrotic syndrome
was significantly lower than infrequent relapse nephrotic syndrome (P<0.001).
Conclusion: During remission after initial attack of nephrotic syndrome, low level
of serum IgG has a relation with frequent relapse nephrotic syndrome and by
measuring serum IgG level in remission we can have an idea whether the patient will
suffer from frequent relapse nephrotic syndrome.

Key words: Predictor, Frequent relapse nephrotic syndrome, Serum IgG

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