Immunosuppressive burden and risk factors of infection in primary childhood nephrotic syndrome

Introduction: Patients with primary childhood nephrotic syndrome (PCNS) develop alterations in their cellular and humoral immunity that predisposes them to the development of infection, and lead them to have frequent relapses. Also, infection could be significantly enhanced by immunosuppressive agents. This study aims to estimate the immunosuppressive burden, rate of infection and identify possible risk factors in PCNS requiring hospitalization. Methodology: A cross-sectional study of hospitalized children ≤ 14 years of age diagnosed with PCNS in King Abdul-Aziz Medical City, Riyadh from January 2003 to December 2013. Result: Out of 111 patients admitted with PCNS, 84 (76%) had both minor and major types of infection. Upper respiratory tract infection (URTI) was the most predominant type (n = 44, 52%). Among the major types of infection, urinary tract infection (UTI) was the most common infection (n = 21, 25%) followed by pneumonia (n = 17, 20%) then cellulitis (n = 6, 6%). Infection in children who received a higher annual cumulative dose of steroids (CDS) strikingly had a higher rate of infection in comparison to those who received lower CDS (p < 0.01). Moreover, those who received primary and secondary immunosuppressant’s had 100% infection rate. Conclusion: About half of infection encountered by PCNS patients were URTI followed by UTI and pneumonia. Higher annual CDS, combination of primary and secondary immunosuppressants were the highest independent risk factors for infection. Among the infection, URTI was considered as the predominant entity whereas among the major infection, UTI was predominant followed by pneumonia then cellulitis. Keywords: Primary childhood nephrotic syndrome, Upper respiratory tract infection, Urinary tract infection, Cumulative dose of steroid