Retrospective Cohort Analysis of Class II Human Leukocyte Antigen (HLA) Alleles in Children With Steroid-Dependent Nephrotic Syndrome Treated With Cyclophosphamide

Background The role of specific human leukocyte antigen (HLA) alleles as a risk factor for susceptibility, protection, and response to cyclophosphamide (CYC) treatment has been studied in patients with idiopathic nephrotic syndrome (INS). This study investigates the association of class II HLA alleles and the treatment outcome in children with steroid-dependent nephrotic syndrome (SDNS) who were treated with CYC. Methods A total of 77 children who were diagnosed with SDNS and had received CYC at least a year before were enrolled. After obtaining informed consent from the parents, blood samples were collected to type the HLA class II locus (DR and DQ) using sequence-specific primers (SSP). An equal number of adult healthy controls (AHC) were included. Results The median age of the study participants at disease onset was five (IQ: 3-7) years with a male-to-female ratio of 1.48:1. The common HLA alleles found in the study cohort and controls were DRB1*7 45 (29%), DRB1*15 30 (19.5%), and DQB1*2 57 (37%), and DRB1*15 31(20%), DRB1*17 36 (23%), DQB1*6 42 (27%), and DQB1*2 38 (25%), respectively. Identification of a particular allele to predict a good or poor response was not statistically significant (p-value >0.05). Conclusion The study demonstrates the common HLA alleles in the cohort. However, a specific allele that can predict a good and poor response to CYP was not identified. Further large-scale, prospective multicenter studies are needed to identify such alleles to decide the use of CYC in the SDNS population judiciously.