To the editor: Hypogammaglobulinemia in nephrotic syndrome (NS) is a condition attributable to increased catabolism and urinary loss of immunoglobulins.1,2



Patients with NS have an increased risk of infection, primarily caused by capsulated germs (pneumococci, Hemophilus influenzae).3,4 There is evidence suggesting that IgG2 are antibodies protecting against pneumococci.



Our purpose was to study recovery of the different immunoglobulin subclasses in patients with NS treated with methylprednisone and deflazacort during remission and relapse.



PATIENTS AND METHODS



Eleven patients with a mean age of 48 months (range, 16-52 months) were studied. An interventional, single blind, clinical study, randomized for treatment start and with treatment crossover after the first relapse, was designed.



Methylprednisone (MPD) was given at 48 mg/m2/day for 6 weeks, followed by 2/3 of the dose every other day for

the next 6 weeks.



The equivalent dose of deflazacort (DFZ) was 72 mg/m2/day (maximum 90 mg/day), with the same therapeutic scheme.



Blood samples were taken at relapse and 40 days after remission was achieved to measure total IgG and its subclasses by the radial immunodiffusion method.



RESULTS



Mean times on remission were 7.8 ± 0.36 days with MPD and 8.3 ± 0.22 days with DFZ.



Mean times to relapse were 85 ± 3.8 days with MPD and 102 ± 4.19 days with DFZ.



Both total IgG and IgG1 similarly recovered with both corticosteroids, but IgG2 and IgG3 only significantly increased with DFZ. Percent recovery of IgG and its subclasses was asymmetric during remission.



IgG1  showed  the  greatest  recovery, while  IgG2  reached  50%  of  normal value. The  same  imbalance was  found with both treatments.



While this was not considered as an objective, it may be stated that the incidence rate of infection by capsulated germs was not significant with both corticosteroids (p0.12) and that less adverse effects occurred when DFZ was used (hypertrichosis, Cushingoid appearance, ocular hypertension, hyperglycemia).



CONCLUSIONS



We found an imbalance in recovery of IgG subclasses during remission of NS treated with both corticosteroids, but a better recovery of such levels was achieved with DFZ.