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Impact of tuberculosis in children with idiopathic nephrotic syndrome
1Department of Paediatrics, Baragwanath Hospital, University of Witwatersrand, Johannesburg, South Africa.
Insights
Tuberculosis (TB) significantly impacts children with focal glomerulosclerosis (FSGS) in South Africa. This co-infection leads to reduced kidney function and increased need for renal replacement therapy in pediatric FSGS patients.
Area of Science:
- Pediatric Nephrology
- Infectious Diseases
- Epidemiology
Background:
- Focal glomerulosclerosis (FSGS) is a significant cause of nephrotic syndrome in children.
- Tuberculosis (TB) is endemic in South Africa, and its association with FSGS in pediatric populations requires investigation.
Purpose of the Study:
- To investigate the prevalence of TB in black South African children diagnosed with FSGS.
- To compare the clinical characteristics, immunological markers, and renal outcomes of FSGS patients with and without concurrent TB infection.
Main Methods:
- Retrospective evaluation of 40 black South African children with idiopathic FSGS.
- Comparison of FSGS patients with TB (FSGS-TB) against those without TB (FSGS-nonTB) and a control group with minimal lesion nephrotic syndrome.
- Assessment of clinical parameters, serum biochemistry, immunoglobulin levels, and estimated creatinine clearance over a mean follow-up of 2.4 years.
Main Results:
- Tuberculosis was diagnosed in 37.5% of children with FSGS, a significantly higher prevalence than in minimal lesion nephrotic syndrome (6%).
- FSGS-TB patients showed elevated serum levels of C4, IgA, and IgM compared to FSGS-nonTB.
- Children with FSGS-TB experienced a significant decline in estimated creatinine clearance (46% reduction) and increased need for renal replacement therapy compared to FSGS-nonTB.
Conclusions:
- Tuberculosis infection is frequently associated with focal glomerulosclerosis in black South African children.
- Concurrent TB infection in pediatric FSGS may adversely affect long-term renal function and increase the likelihood of requiring renal replacement therapy.
Abstract:
Forty black South African children (mean age 4.7 +/- 2.6 years) with idiopathic nephrotic syndrome due to focal glomerulosclerosis (FSGS) were evaluated. Tuberculosis (TB) was found in 37.5% of children with FSGS (FSGS-TB) compared with 6% of a comparable group with minimal lesion nephrotic syndrome. No significant differences were found in the initial mean serum albumin, cholesterol, triglyceride and creatinine levels in FSGS-TB compared with children with glomerulosclerosis but without TB (FSGS-nonTB). The mean serum levels of C4, IgA and IgM were increased by 30%, 25% and 23%, respectively in children with FSGS-TB compared with FSGS-nonTB. Initial estimated creatinine clearance was similar in the two groups, but after a mean follow-up of 2.4 years, the mean estimated creatinine clearance of children with FSGS-TB was significantly reduced by 46% from the initial value, but remained stable in the FSGS-nonTB group. FSGS-TB children also had significantly increased requirements for renal replacement therapy compared with children with FSGS-nonTB. We conclude that TB infection is commonly associated with FSGS in black South African children; this may have deleterious effects on renal function.