Unraveling BCR Repertoire Diversity and its Impact on Glucocorticoid Therapy in Pediatric Idiopathic Nephrotic Syndrome

B-cell-mediated humoral immunity plays a pivotal role in INS pathogenesis, with distinct immune profiles associated with clinical outcomes. Non- refractory nephrotic syndrome (NRNS) patients exhibit clonal expansion with antigen-driven immune responses, whereas SRNS and RNS patients demonstrate persistent IgE-mediated responses that are resistant to GC but sensitive to second-line immunosuppressants. These findings offer new insights into the mechanisms of steroid resistance and provide a basis for early diagnosis and personalized treatment strategies in INS.