American Journal of Medical Sciences and Medicine
ISSN (Print): 2327-6681 ISSN (Online): 2327-6657 Website: http://www.sciepub.com/journal/ajmsm Editor-in-chief: Apply for this position
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American Journal of Medical Sciences and Medicine. 2019, 7(1), 6-8
DOI: 10.12691/ajmsm-7-1-2
Open AccessArticle

Risk Factor of Tuberculosis in Children with Nephrotic Syndrome who Received Immunosuppressant Therapy in Hasan Sadikin Hospital

Sitoresmi Prabaningrum1, , Diah Asri1 and Dedi Rachmadi1

1Department of Child Health, Faculty of Medicine, Universitas Padjadjaran/Hasan Sadikin General Hospital, Bandung, Indonesia

Pub. Date: February 03, 2019

Cite this paper:
Sitoresmi Prabaningrum, Diah Asri and Dedi Rachmadi. Risk Factor of Tuberculosis in Children with Nephrotic Syndrome who Received Immunosuppressant Therapy in Hasan Sadikin Hospital. American Journal of Medical Sciences and Medicine. 2019; 7(1):6-8. doi: 10.12691/ajmsm-7-1-2

Abstract

Patients with nephrotic syndrome (NS) are in immunocompromised condition due to illness and therapy given. Treatment of NS with long-term steroids, high doses and combination with cyclophosphamide decreases body resistance. Immunocompromised conditions facilitate the occurrence of infection, one of the infections that might occur is tuberculosis (TB) with a high incidence in Indonesia. The aim of the study was to investigate the risk factors of TB in children with NS, specifically related to the duration of steroids administration, and combinations of steroids with cyclophosphamide. This was cross sectional study data retrieval from out-patients and in-patients NS children in RS Hasan Sadikin Bandung (RSHS) during 1st January 2012 until 31st December 2016. Statistical analysis using chi-square test and multiple logistic regression. There were 34 children with TB from 199 NS patients, the prevalence of TB in children with NS in RSHS (17%). The results showed that duration of steroids administration, combination of steroids and cyclophosphamide, female gender, and under nutrition were significant to tuberculosis incidence (p <0.001). Multiple logistic regression analysis revealed duration of steroid 175,5 days OR 20,7 (CI95% 7,5-68,1); p<0.001, combination of steroids with cyclophosphamide OR 3,2 (CI95% 1,1-11,7); p=0,027, female gender OR 2,5 (CI95% 0,9-7,2); p=0,077, and under nutrition OR 7,2 (CI95% 2,4-3,7); p=0.001. Duration of steroid administration, combination of steroids with cyclophosphamide, female gender, and under nutrition were risk factors for tuberculosis. The duration of steroid administration was the most dominant factor in the incidence of tuberculosis in children with NS.

Keywords:
child tuberculosis immunosuppressant nephrotic syndrome

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References:

[1]  Bagga A, Mantan M, Nephrotic syndrome in children, Indian J Med Res, India, 2005, 13-28.
 
[2]  Niaudet P, Boyer O, Idiopathic nephrotic syndrome in children: clinical aspect. In: Avner E, Harmon W, Niaudet P, Yoshikawa N (ed), Springer, Berlin, 2009, 667-702.
 
[3]  Cohen E, Nephrotic syndrome, Medscape, 2016, 1-20.
 
[4]  Latta K, Schnakenburg C, Ehrich J, A meta analysis of cytotoxic treatment for frequently relapsing nephrotic syndrome in children. Pediatr Nephrol, 2001; 16: 271-282.
 
[5]  Direktorat Jenderal Pencegahan dan Pengendalian Penyakit, Petunjuk teknis manajemen dan tatalaksana TB pada anak, Kementerian Kesehatan Republik Indonesia, Jakarta: 2016.
 
[6]  Onal CO, Kibaroglu E, Pulmonary tuberculosis caused by immunosuppresive treatment, J Clin Case Rep, USA, 2014, 4-7.
 
[7]  Li S, Zhang M, Chen , An implication of relationship between tuberculosis and primary nephrotic syndrome, Int J Artif Organs and SAGE, China, 2015,178-83.
 
[8]  Narasimhan P, James W, Raina M, Mathai D, Risk factor for tuberculosis, Hindawi, India, 2013, 1-11.
 
[9]  Tambunan T, Dewati A, madiyono B, Rahayoe N. Pulmonary tuberculosis in childhood nephrotic syndrome (A cross sectional study). Paediatr Indones, Indonesia, 2001, 106-10.
 
[10]  Gulati S, Kher V, Gulati K, Arora P, Gujral R. Tuberculosis in childhood nephrotic syndrome in India. Pediatr Nephrol, India, 1997, 695-8.
 
[11]  Liu D, Ahmet A, Ward L, Krishnamoorthy P, A practice guide to the monitoring and management of the complication of systemic corticosteroid therapy, AACI jounal, Canada,2013, 1-25.
 
[12]  Youssef J, Novosad S, Winthrop K, Infection risk and safety of corticosteroid use. Rheum Dis Clin North Am 2017; 42: 1-4.
 
[13]  Rather P, Channudhary H, Rathhee S, Immunosuppressant: A review, Theparmajourn, India, 2013, 90-92.
 
[14]  Shi R, Sugawara I, Pathophysiology of tuberculosis, Tuberculosis current issues in diagnosis and management. Intech Open Science 2000: 127-139.
 
[15]  Hogg R, Middleton J, Vehaskari M, Focal segmental glomerulosclerosis-epidemiology aspect in children and adults. Pediatr Nephrol, 2007; 22: 183-186