Background: Hemodialysis (HD) procedure per se as well as disturbances in both innate and adaptive immunity makes HD patients susceptible to infections. Infections are the major cause of morbidity and the second cause of death following cardiovascular events in HD patients. Aim: Was to study lymphocyte subset counts in children with chronic kidney disease on regular hemodialysis in comparison with normal subjects to clarify the abnormalities in cellular immune profile. Patients and methods: The study included 40children with chronic kidney disease on regular hemodialysis and 20 healthy control (HC) children age and sex matched as a control group, they were selected from the pediatric hemodialysis unit and out patients clinic of AL-zahraa hospital ,Al-Azher university during the period from September 2013to June 2014. We examined the number of the peripheral lymphocytes. Also quantification of (T CD3+ & B CD19+) lymphocytes and T cell subsets including T helper CD3+CD4+, T cytotoxic CD3+ CD8+, CD4/CD8 ratio, and NK cells CD3-CD56+ using flow cytometric analysis and correlates their number with clinical and laboratory characteristics. Results: The total peripheral blood lymphocyte count was lower in HD children (2.3 x10³/uL) than HC children (3 x10³/uL), also T lymphocytes CD3+ counts were reduced in HD children (1609.25 ±545.77 / uL) than HC (2114.20± 868.39 /uL), (p=0.008), numbers of CD4+ T cells were not different, but numbers of CD8+ T cells were lower in HD children (600.67±284.92) compared with HC (896.80±573.00) (p < 0.05). Decrease in NK cell counts CD3-CD56+ in HD children (175.35±107.44) in comparison to HC (271.30±169.94). The B lymphocyte count CD19+ was not different in HD children (260±201.6) compared with healthy controls (250.20±122.84). A positive correlation was found between B lymphocytes CD19+ with hemodialysis duration. A negative correlation between NK cell counts and BUN, age and also with patients weight and height were found. Conclusion: The reduced numbers of lymphocyte count, T lymphocytes CD3+counts, CD8+ T cells as well as NK cell in CKD children on regular hemodialysis may favor the frequent occurrence of infections in spit the normal number of the other studied t cell subsets.
Manal Abd El-Salam,
Shaimaa Abdelmalik Pessar,
Peripheral Blood Lymphocyte Subsets Counts in Children on Regular Hemodialysis, International Journal of Immunology.
Vol. 3, No. 1,
2015, pp. 1-6.
Alvarez-Lara MA, Carracedo J, Rafael RR, Alejandro MM, Mariano R, Juan AM and Pedro A .The imbalance in the ratio of Th1 and Th2 helper lymphocytes in uraemia is mediated by an increased apoptosis of Th1 subset1 Nephrol Dial Transplant 2004; 19: 3084–3090.
Eleftheriadis T, Liakopoulos V, Leivaditis K, Antoniadi G, Stefanidis I. Infections in hemodialysis: a concise review. Part II: blood transmitted viral infections. Hippokratia 2011; 15(2): 120–126.
Kurz P, Kohler H, Meuer S, Hutteroth T, Meyer zum Buschenfelde KH . Impaired cellular immune responses in chronic renal failure: Evidence for a T cell defect. Kidney Int 1986; 29: 1209–1214.
4 Quadracci LJ, Ringden O, Krzymanski M . The effect of uremia and transplantation on lymphocyte subpopulations. Kidney Int1976; 10: 179–184.
Raska K Jr, Raskova J, Shea SM, Frankel RM, Wood RH, Lifter J, Ghobrial I, Eisinger RP, Homer L . T cell subsets and cellular immunity in end-stage renal disease. Am J Med 1983;75: 734–740.
6 Cendroglo M, Jaber BL, Balakrishnan VS, Perianayagam M, King AJ, Pereira BJ. Neutrophil apoptosis and dysfunction in uremia. J Am Soc Nephrol 1999 ;10: 93–100.
Ferna ndez-Fresnedo G, Ramos MA, Gonzalez-Pardo MC, Martı´n de Francisco AL, Lo´ pez-Hoyos M, Arias M (2000): B lymphopenia in uremia is related to an accelerated in vitro apoptosis and dysregulation of Bcl-2. Nephrol Dial Transplant; 15: 502–510.
Kaul H, Girndt M, Sester U, Sester M, Ko¨ hler H . Initiation of hemodialysis treatment leads to improvement of T cell activation in patients with end-stage renal disease. Am J Kidney Dis 2000; 35: 611–616
Krishnamurthy G, Kher V, Naik S. Low response to HBsAg vaccine in chronic renal failure patients is not due to intrinsic defect of B cells. Scand J Urol Nephrol 2002; 36: 377–382.
Sester U, Sester M, Hauk M, Kaul H, Kohler H, Girndt M . T-cell activation follows Th1 rather than Th2 pattern in haemodialysis patients. Nephrol Dial Transplant 2000; 15: 1217–1223.
Libetta C, Rampino T, Dal Canton A . Polarization of T-helper lymphocytes toward the Th2 phenotype in uremic patients. Am J Kidney Dis 2001; 38: 286–295.
Wilson K and Walker J. Principle and technology of biochemistry and molecular biology 2005; Six edition.
Chung BH, Kim KW, Sun IO, Choi SR, Park HS, Jeon EJ, et al. Increased interleukin-17 producing effector memory T cells in the end-stage renal disease patients. Immunol Lett 2012 ;141(2):181-9.
Van Pottelbergh G, Bartholomeeeusen S, Buntix F, Degryse J. The evolution of renal function and the incidence of end-stage renal disease in patients aged $50 years. Nephrol Dial Transplant 2011; 27(6):2297-303.
Vaziri ND, Pahl MV, Crum A, Noris K. Effect of uremia on structure and function of immune system. J Ren Nutr 2012; 22(1):149–56.
Meuer SC, Hauer M, Kurz P et al. Selective blockade of the antigen receptor mediated pathway of T cell activation in patients with impaired primary immune responses. J Clin Invest 1957; 80:743 749.
Stachowski J, Pollok M, Burrichter H et al. Signaling via the TCR/CD3 antigen receptor complex in uremia is limited by the receptors number. Nephron 1993; 64:369 375.
Reddan DN, Klassen PS, Szczech LA et al. White blood cells as a novel mortality predictor in haemodialysis patients. Nephrol Dial Transplant 2003 ; 18: 1167–1173
Fernandez-Fresnedo G, Ramos MA, Gonzalez-Pardo MC, Martı´n de Francisco AL, Lo´ pez-Hoyos M, Arias M. B lymphopenia in uremia is related to an accelerated in vitro apoptosis and dysregulation of Bcl-2. Nephrol Dial Transplant 2000; 15: 502–510.
Descamps–Latscha B, Chatenoud L .T cells and B cells in chronic renal failure. Semin Nephrol 1996; 16:183–91.
Chatenoud L, Herbelin A, Beaurain G, Descamps–Latscha B .Immune deficiency of the uremic patient. Adv Nephrol Necker Hosp1990; 19:259–74.
Furth SL, Neu AM, McColley SA, Case B, Steinhoff M, Fivush B. Immune response to influenza vaccination in children with renal disease. Pediatr Nephrol 1995; 9:566–8.
Kawano Y, Noma T, Yata J. Regulation of human IgG subclass production by cytokines. IFN-gamma and IL- 6 act antagonistically in the induction of human IgG1 but additively in the induction of IgG2. J Immunol 1994; 53:4948–58.
Yoon JW, Gollapudi S, Pahl MV, Vaziri ND. Naıve and central memory T-cell lymphopenia in end-stage renal disease. Kidney Int 2006; 70(2):371-6.
Yaghoubian A, Ge P, Tolan A, Saltmarsh G, Kaji AH, Neville AL, et al. . Renal insufficiency predicts mortality in geriatric patients undergoing emergent general surgery. Am Surg 2011; 767(10):1322-5.
Lewis SL, Bonner PN, Cooper CL, Holmes CJ. Prospective comparison of blood and peritoneal lymphocytes from continuous ambulatory peritoneal dialysis patients. J Clin Lab Immunol1992; 37:3–19.
Cohen G, Haag–Weber M, Horl WH. Immune dysfunction in uremia. Kidney Int 1997; 52(62):79–82.
Bender BS, Curtis JL, Naegel JE, Chrest FJ, et al. Analysis of the immune status of hemodialyzed adults: Association with prior transfusion .Kidney Int 1984; 26:436-443.
Morra L, Ponassi GA, Gurreri G, Moccia F, Mela GS, Bessone G. T lymphocyte subsets in chronic uremic patients treated with maintenance hemodialysis. Biomed Pharmacother1990; 44:53–6.
Vacher-Coponat H, Brunet C, Lyonnet L, Bonnet E, Loundou A, Sampol J, et al. Natural killer cell alterations correlate with loss of renal function and dialysis duration in uraemic patients. Nephrol Dial Transplant 2008; 23(4):1406-14.
Kay NE and Raij L. Immune abnormalities in renal failure and hemodialysis. Blood purification 1986; 4:120-129.
Fouque D, Kalantar-Zadeh K, Kopple J, Cano N, Chauveau P, Cuppari L, Franch H, Guarnieri G, Ikizler TA, Kaysen G, Lindholm B, Massy Z, Mitch W, Pineda E, Stenvinkel P, Trevinho-Becerra A, Wanner C . A prop osed nomenclature and diagnostic criteria for protein-energy wasting in acute and chronic kidney disease. Kidney Int 2008; 73: 391–398.
Lotzova E. Definition and functions of natural killer cells. Nat Immun1993; 12:169–76.
Milne CD, Paige CJ. IL-7: a key regulator of B lymphopoiesis. Semin Immunol 2006; 18(1):20–30.
Kalled L. Impact of the BAFF/BR3 axis on B cell survival, germinal center maintenance and antibody production. Semin Immunol 2006; 18(5):290–6.
Bouts A, Davin J, Krediet R. Children with chronic renal failure have reduced numbers of memory B cells. Clin Exp Immunol 2004; 137(3):589–94.
Pahl MV, Gollapudi S, Sepassi L, Gollapudi P, Elahimehr R, Vaziri ND . Effect of end-stage renal disease on B-lymphocyte subpopulations, IL-7, BAFF and BAFF receptor expression. Nephrol Dial Transplant 2010; 25(1):205–12.
Kaul H, Girndt M, Sester U, Sester M, Kohler H. Initiation of hemodialysis treatment leads to improvement of T cell activation in patients with end-stage renal disease. Am J Kidney Dis2000; 35: 611–616
Coles GA, Lewis SL, Williams JD. Host defence and effects of solutions on peritoneal cells. In: Gokal R, Nolph KD, eds. The textbook of peritoneal dialysis. 1st ed. Dordrecht: Kluwer Academic Publishers1994; 503–28.
Lewis SL, Kutvirt SG, Cooper CL, Bonner PN, Holmes CJ. Characteristics of peripheral and peritoneal lymphocytes from continuous ambulatory peritoneal dialysis patients. Perit Dial Int1993; 13(2):273–7.
Degiannis D, Mowat AM, Galloway E, Tsakiris D, Briggs JD, Junor BJ, et al . In vitro analysis of B lymphocyte function in uraemia. Clin Exp Immunol 1987; 70:463–70