الفهرس 
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Abstract
Summary
Macrophage migration inhibitory factor (MIF) is a pro-inflammatory cytokine implicated in acute and chronic inflammatory conditions, including sepsis, autoimmune disease, atherogenesis, plaque instability, and pulmonary arterial hypertension. MIF in plasma and urine is significantly elevated in patients with acute kidney injury (AKI) and elevated MIF in serum is associated with markers of oxidative stress, endothelial dysfunction, arterial stiffness, and markers of myocardial damage in chronic kidney disease (CKD). Furthermore, MIF seems to be involved in vascular processes and cardiovascular disease associated with CKD, glomerulonephritis, autosomal dominant polycystic kidney disease, and possibly also in progression to renal failure.
Idiopathic Nephrotic Syndrome (NS) represents a heterogeneous group of glomerular disorders occurring mainly in children. Generally, NS is divided into steroid sensitive (SSNS) and Steroid Resistant Nephrotic Syndrome (SRNS), depending on the response to steroid therapy. SRNS accounts for more than 10% of children who progress to chronic kidney disease. This group of NS has in common permanent loss of selectivity of the glomerular barrier to protein filtration. It has been recognized that patients with persistent high grade proteinuria are more likely to develop chronic kidney disease than patients with low grade or no proteinuria.
The aim of the study was to investigate the plasma levels of macrophage migration inhibitory factor (MIF) in patients with INS undergoing steroid treatment, in order to elucidate whether there it can serve as biomarker to predict treatment efficacy.
The study was conducted in the period from April 2021 to October 2021 and will include 90 children, seventy of them were with INS twenty were healthy control children. The study population were subdivided into 3 groups; Steroid sensitive (SS) nephrotic syndrome patients: 38 patients, Steroid resistant (SR) nephrotic syndrome patients: 32 patients, and healthy control children, 20 children.
The main findings of the study revealed that:
• The mean age in cases was 9.29± 3.22 years and in control was 7.65± 2.92 years. Height was significantly lower in patients than controls. BMI was significantly higher in cases than controls.
• Disease duration was significantly lower in SSNS compared to SRNS while BMI was significantly higher in SRNS compared to controls without significant differences between SSNS and controls.
• Systolic and diastolic blood pressures were significantly higher in patients compared to controls. Systolic BP was significantly higher in SSRNS and SRNS compared to controls, 14% of patients were hypertensive.
• Urea, creatinine, PCR, WBCs, and plasma MIF were significantly higher in patients than controls.
• PCR was significantly higher in SRNS compared to SSNS and controls without significant differences between the SSNS and controls. Plasma MIF levels were significantly higher in SRNS compared to SSNS and controls with levels without significant differences between the SSNS and controls.
• There was no significant difference between FSGS and MCD in the SRNS group as regards laboratory data.
• There was significant positive moderate correlation between plasma MIF and protein/ creatinine ratio.
Based on our findings, we conclude that plasma MIF could be a good biomarker for steroid resistance in INS.