Infectious complications in adult patients with idiopathic minimal change nephrotic syndrome undergoing immunosuppressive therapy

Hsu, Chih‐Yang; Chang, Chung Chou H.; Chen, Hsin‐Yu; Ou, Shih-Hsiang; Chou, Kang‐Ju; Fang, Hua‐Chang; Chen, Chien‐Liang; Huang, Chien‐Wei; Ho, Tzung‐Yo; Lee, Po‐Tsang

doi:10.1111/nep.14119

Cited by 3 publications

(2 citation statements)

References 28 publications

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“…A previous study on 101 adult NS patients [5], found that 17 (16.8%) developed infectious complications, mainly pneumonia, cellulitis, fasciitis, and urinary tract infections, primarily caused by Gram-negative bacilli. Notably, three deaths occurred due to mycobacterium tuberculosis pneumonia, pseudomonas aeruginosa infection, and acute hepatitis B are.…”

Section: Introductionmentioning

confidence: 92%

Association between nephrotic syndrome and tuberculosis in ICU patients: A cross-sectional study of the MIMIC-IV database

Du,

Su,

et al. 2024

Preprint

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Background This study investigated hospital mortality rates among patients with nephrotic syndrome (NS) and tuberculosis (TB) using data from the Medical Information Mart for Intensive Care IV version 2.2 (MIMIC-IV v2.2) database. The aim was to assess the impact of TB infection on in-hospital mortality risk in NS patients. Methods A total of 2167 NS patients were enrolled, among whom 1079 were co-infected with TB. Potential confounding factors included demographics, vital signs, laboratory values, acute physiology score, clinical treatments, and comorbidities. Univariate logistic regression was conduted to identify in-hospital mortality risk factors and multivariable multifactorial logistic regression was performed to explore the TB’s impact on in-hospital mortality. A restricted cubic spline regression analysis was carried out to investigate the linear relationship between hemoglobin, albumin, and in-hospital mortality. Stratified analyses were conducted for age, gender, sepsis, and acute kidney injury(AKI) stage to determine their effect on mortality of NS co-infected with TB. Results The prevalence of NS co-infected with TB was 49.8%, with a 14.6% in-hospital mortality rate, representing a 44% increased risk (P=0.005). The adjusted multivariable analysis revealed a mortality risk exceeding 20%. Among patients with sepsis, the incidence was 48.3% in those without TB and 46.7% in those co-infected with TB, with a 63% incidence of AKI within 7 days. Sepsis was associated with a 2.54-fold increase in mortality risk, and AKI stage 3 had an odds ratio (OR) of 9.03. Subgroup analyses suggested that both sepsis and AKI were independent risk factors for mortality. Hemoglobin and albumin exhibitedL-shaped linear relationships with in-hospital mortality, acting as protective factors below the inflection point. Only 1.8% received steroid treatments (NS 2.6%, NS and TB 0.9%), and 10.1% underwent continuous renal replacement therapy. Conclusions Our study results revealed significantly increased in-hospital mortality risk among NS patients with concurrent TB infection, alongside numerous complications. Sepsis and AKI independently increase mortality risk in NS patients co-infected with TB. These findings inform disease severity assessment and prognosis determination in adult NS patients with TB co-infection.

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Section: Introductionmentioning

confidence: 92%

Association between nephrotic syndrome and tuberculosis in ICU patients: A cross-sectional study of the MIMIC-IV database

Du,

Su,

et al. 2024

Preprint

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“…Most studies have focused on the response to immunosuppressive treatment in NS, kidney outcomes ( 7–9 ), and mechanisms and prevention of acute kidney injury (AKI) ( 10–13 ), with limited literature on adult NS patients with concurrent TB infection. Hsu et al ( 14 ) observed an incidence rate of infectious complications of 16.8% (17/101) in adult NS patients, primarily pneumonia, cellulitis/fasciitis, and urinary tract infections, with one of the three deaths due to TB pneumonia. In the 5 years following the United Nations High-Level Meeting in 2018, over 7 million people died from TB globally, with an estimated 10.6 million people contracting TB in 2021 ( 2 , 15 ).…”

Section: Introductionmentioning

confidence: 99%

A prediction model for prognosis of nephrotic syndrome with tuberculosis in intensive care unit patients: a nomogram based on the MIMIC-IV v2.2 database

Du,

Su,

et al. 2024

Front. Med.

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BackgroundCurrently, a scarcity of prognostic research exists that concentrates on patients with nephrotic syndrome (NS) who also have tuberculosis. The purpose of this study was to assess the in-hospital mortality status of NS patients with tuberculosis, identify crucial risk factors, and create a sturdy prognostic prediction model that can improve disease evaluation and guide clinical decision-making.MethodsWe utilized the Medical Information Mart for Intensive Care IV version 2.2 (MIMIC-IV v2.2) database to include 1,063 patients with NS complicated by TB infection. Confounding factors included demographics, vital signs, laboratory indicators, and comorbidities. The Least Absolute Shrinkage and Selection Operator (LASSO) regression and the diagnostic experiment the receiver operating characteristic (ROC) curve analyses were used to select determinant variables. A nomogram was established by using a logistic regression model. The performance of the nomogram was tested and validated using the concordance index (C-index) of the ROC curve, calibration curves, internal cross-validation, and clinical decision curve analysis.ResultsThe cumulative in-hospital mortality rate for patients with NS and TB was 18.7%. A nomogram was created to predict in-hospital mortality, utilizing Alb, Bun, INR, HR, Abp, Resp., Glu, CVD, Sepsis-3, and AKI stage 7 days. The area under the curve of the receiver operating characteristic evaluation was 0.847 (0.812–0.881), with a calibration curve slope of 1.00 (0.83–1.17) and a mean absolute error of 0.013. The cross-validated C-index was 0.860. The decision curves indicated that the patients benefited from this model when the risk threshold was 0.1 and 0.81.ConclusionOur clinical prediction model nomogram demonstrated a good predictive ability for in-hospital mortality among patients with NS combined with TB. Therefore, it can aid clinicians in assessing the condition, judging prognosis, and making clinical decisions for such patients.

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Preventing infections in immunocompromised patients with kidney diseases: vaccines and antimicrobial prophylaxis

Windpessl

Kostopoulou

Conway

et al. 2023

Nephrology Dialysis Transplantation

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The Coronavirus Disease 2019 (COVID-19) pandemic revealed that our understanding of infectious complications and strategies to mitigate severe infections in patients with glomerular diseases is limited. Beyond COVID-19, there are several infections which specifically impact care of patients receiving immunosuppressive measures. This review will provide an overview of six different infectious complications frequently encountered in patients with glomerular diseases, and will focus on recent achievements in terms of vaccine developments and understanding of the use of specific antimicrobial prophylaxis. These include influenza virus, Streptococcus pneumoniae, reactivation of a chronic or past infection with hepatitis B virus (HBV) in cases receiving B-cell depletion, reactivation of cytomegalovirus (CMV), and cases of Pneumocystis jirovecii pneumonia (PJP) in patients with anti-neutrophil cytoplasmic antibody (ANCA)-associated vasculitis. Varicella zoster virus (VZV) infections are particularly frequent in patients with systemic lupus erythematosus (SLE) and an inactivated vaccine is available to be used as alternative to the attenuated vaccine in patients receiving immunosuppressants. As with COVID-19 vaccines, vaccine responses are generally impaired in older patients, and after recent administration of B-cell depleting agents, high doses of mycophenolate mofetil and other immunosuppressants. Strategies to curb infectious complications are manifold and will be outlined in this review.

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Infectious complications in adult patients with idiopathic minimal change nephrotic syndrome undergoing immunosuppressive therapy

Cited by 3 publications

References 28 publications

Association between nephrotic syndrome and tuberculosis in ICU patients: A cross-sectional study of the MIMIC-IV database

Association between nephrotic syndrome and tuberculosis in ICU patients: A cross-sectional study of the MIMIC-IV database

A prediction model for prognosis of nephrotic syndrome with tuberculosis in intensive care unit patients: a nomogram based on the MIMIC-IV v2.2 database

Preventing infections in immunocompromised patients with kidney diseases: vaccines and antimicrobial prophylaxis

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