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NDT Advance Access originally published online on December 18, 2007
Nephrology Dialysis Transplantation 2008 23(4):1422-1428; doi:10.1093/ndt/gfm788
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© The Author [2007]. Published by Oxford University Press on behalf of ERA-EDTA. All rights reserved. For Permissions, please e-mail: journals.permissions@oxfordjournals.org


Glucocorticoid resistance in dialysis patients may impair the kidney allograft outcome

Sergio R. De Antonio, Luciana T. S. Saber, Rosangela S. Chriguer and Margaret de Castro

Department of Internal Medicine, School of Medicine of Ribeirao Preto, University of Sao Paulo, Avenida dos Bandeirantes, 3900, 14049-900, Ribeirao Preto, SP, Brazil

Margaret de Castro, School of Medicine of Ribeirao Preto, University of Sao Paulo, Avenida dos Bandeirantes, 3900, 14049-900, Ribeirao Preto, SP, Brazil. Tel: +55-16-3602-2940; Fax: +55-16-3633-6695; E-mail: castrom{at}fmrp.usp.br



  Abstract

This study examines in vitro steroid sensitivity in chronic renal failure (CRF) patients and its influence on the allograft outcome. We determined the inhibitory effect of dexamethasone (DEX) on concanavalin A (Con-A)-stimulated peripheral blood mononuclear cell (PBMC) proliferation, and glucocorticoid receptor' (GR) number of binding sites (Bmax) and affinity (Kd) in 28 CRF patients and 40 normal healthy controls. Based on Kd values >95th percentile from controls, patients were divided into two groups: glucocorticoid resistant (n = 11) and glucocorticoid sensitive (n = 17). Patients were followed during 18 months post-transplantation observing acute rejection episodes (ARE), chronic allograft nephropathy (CAN), allograft failure and death. The DEX concentration that caused 50% inhibition of Con-A-stimulated PBMC proliferation (IC50) was higher in CRF than in healthy controls (2.2 x 10–5 ± 1.0 x 10–5 versus 8.3 x 10–6 ± 4.2 x 10–6 mol/L, P = 0.02). Values of Kd (12.4 ± 1.8 versus 7.2 ± 0.9 nM) and Bmax (7.7 ± 1.1 versus 4.1 ± 0.3 fmol/mg protein) were higher in CRF patients (P = 0.02 and P = 0.001, respectively). There were higher incidences of ARE (P = 0.02) and CAN (P = 0.002) in the glucocorticoid-resistant group. Univariate and multivariate logistic regression showed that Kd was an independent predictor of ARE (OR 8.8, P = 0.03) as well as of CAN (OR 16.5, P = 0.01). In conclusion, we observed glucocorticoid resistance in a subgroup of CRF patients undergoing dialysis, which led to a higher morbidity due to ARE and CAN in an 18-month follow-up period.

Received for publication: 3. 7.07
Accepted in revised form: 9.10.07


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