Cryptococcosis in Patients with Nephrotic Syndrome: A Pooled Analysis of Cases

Cryptococcosis is an infection that may be lethal in patients with nephrotic syndrome (NS). However, there is relatively limited epidemiological and clinical data about cryptococcosis in NS patients. We performed a pooled analysis to systemically summarize the epidemiology, risk factors, clinical and laboratory characteristics, treatments and outcomes of cryptococcosis in NS patients. Using data pooled from our hospital and studies identified via searches of three literature databases, 17 cases were identified for inclusion in this analysis. The prevalence of cryptococcosis in NS was 0.3%, with a higher rate in more recent years. Most patients were Asian (94%) and from upper-middle to high-income countries (76%). The median time interval from NS diagnosis to cryptococcosis diagnosis among the cryptococcosis patients was 16 months, and 46% of the identified cryptococcal infections were diagnosed within the first year of NS diagnosis. Cutaneous cryptococcosis was frequently diagnosed among the included patients (35%), 58% received an erroneous diagnosis and inappropriate treatment, 90% of whom had a cryptococcal infection mistaken for a bacterial infection. The mortality rate was 35%. Standard therapeutic strategies should be emphasized for both antifungal treatment and renal disease control. Further studies conducted in various medical centers are warranted to confirm our conclusions.