Nuclear Factor Kappa B (NF-kB) in Patients with Nephrotic Syndrome and Acute Renal Failure

Background: In renal tissue injury, activation of the transcription factor NF-kB has a central role in the induction of proinflammatory genes expression, which are involved in the development of progressive renal inflammatory disease.Aim of Work: The aim of our study was to evaluate the in situ expression of activated transcription factors NF-kB in renal biopsy sections of patients with nephrotic syndrome and acute renal failure and to study its role as a prognostic marker in proteinuric renal disease and acute renal failure by correlating its level with follow-up investigations of glomerulonephritis after 3 months of treatment. The study included 30 patients with acute renal failure and nephrottic syndrome recruited from nephrology clinic in Kasr El-Aini Hospital and King Fahd unit during year 2007 till 2010. The patients were divided in 3 groups: Group I included 10 patients with idiopathic nephrotic syndrome due to various glomerulonephropathies, group II included 10 patients presenting with nephrotic syndrome due to focal segmental glomerulosclerosis (FSGS), group III included 10 patients presenting with acute renal failure (ARF).Results: By comparing NF-kB in different groups it was highest in group 3 including patients with acute renal failure. Results showed no significant difference in relation to the two pathological entities that were found, acute interstitial nephritis (mean: 1102.7 density/mm², ±SD 548.4) and acute tubular necrosis (ATN) (mean 1222.5, ±SD 432.0). On evaluation of NF-kB levels in patients with nephrotic syndrome resulted in, that patients with membranoproliferative ( MPGN) had the highest levels, mean 795 density/mm² SD±643.5, followed by the mesangioproliferative (MesPGN) patients, mean 598.7, SD±166.5. The lowest levels were found in patients with membranous nephropathy, mean 387.5 and SD±101.1. Taking the patients as one group before treatment, NF-kB showed significant positive correlation with, mean BP, the serum creatinine level (r=0.531, p= 0.01) and inverse correlation with proteinuria (r=0.415, p= 0.05). Logistic Regression analysis was done to evaluate the NF-kB as a predictor of outcome showing that NF-kB isn’t predictor for outcome in any group of the three.Conclusion: The study shows that NF-kB levels are higher in patients with severe degrees of tubulointerstitial injury. Hence, it can be utilized as a marker of disease severity within this regard. Our results have also showed that, higher levels of NF-kB were detected MPGN more than other disease forms with the membranous nephropathy having the lowest levels. Our results didn’t prove NF-kB as a prognostic tool in glomerulonephritis and acute injury probably due to small numbers of patients.