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1054 IN VITRO IMMUNOGLOBULIN SYNTHESIS IN IDIOPATHIC NEPHROTIC SYNDROME (INS)

On the basis of serum immunoglobulin levels it has been suggested (NEJM, 293:8, 1975) that INS is caused by an immunologic defect similar to dysgammaglobulinemia with elevated IgM (DYS-M). We therefore compared the in vitro immunoglobulin production of pokeweed mitogen stimulated blood lymphocytes from 7 patients with INS (biopsy or a compatible clinical course) and 2 with DYS-M. All patients with INS were in relapse but had not taken immunosuppressants for the previous 6 months. Serum IgG was low in 6/7 patients with INS, but IgA was normal in all and IgM elevated in only one. Patients with DYS-M had low serum IgG, absent IgA but normal or high IgM. The in vitro immunoglobulin synthesis results were (x ± S.D.):Patients with DYS-M but not INS produced significantly (p<.05) less immunoglobulins of each class than did normals. No suppressor cells were demonstrated. These results indicate that patients with INS do not have the same immunologic defect as patients with DYS-M. The role of soluble inhibitors of synthesis or increased catabolism in the reduction of serum IgG levels remains unknown.