Significance of trace deposition of immunoglobulin M in glomerular mesangium in children with minimal change nephrotic syndrome

Objective To study the significance of trace immunoglobulin M(Ig M) deposits in glomerular mesangium in children with minimal change primary nephrotic syndrome(PNS). Methods One hundred and six children who were clinically diagnosed with PNS and pathologically diagnosed with minimal change disease(MCD) and trace deposition of Ig M in renal tissues were enrolled as subjects. Eighty-one PNS children with MCD but no deposition of immune complexes were used as the control group. The clinical characteristics and effi cacies of glucocorticoids and immunosuppressants were retrospectively analyzed in the two groups. All patients were given full-dose prednisone by oral administration, and patients with glucocorticoid resistance or frequent relapses were additionally given immunosuppressants. Results The incidence of glucocorticoid resistance in the Ig M deposit group was signifi cantly higher than that in the control group(27.2% vs 12.3%; P0.05). The incidence of frequent relapses in the Ig M deposit group was also signifi cantly higher than that in the control group(48.1% vs 10.4%; P0.05). The complete remission rate for glucocorticoid-resistant patients treated with prednisone combined with mycophenolate mofetil(MMF) was 68% and 62% respectively in the Ig M deposit and control groups(P0.05). The relapse frequency in patients with frequent relapses was signifi cantly reduced in both groups after treatment with prednisone and MMF in combination(P0.05). Conclusions Trace deposition of Ig M in renal tissues may be an important factor for glucocorticoid resistance and frequent relapses in PNS children with MCD. Prednisone combined with MMF may be a better choice in the treatment of patients with glucocorticoid resistance or frequent relapses.