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Takao H, Nishi K, Funaki T, Inoki Y, Osaka K, Nada T, Yokota S, Sato M, Ogura M, Ishikura K, Ishiguro A, Kamei K. Changes in Patterns of Infection Associated with Pediatric Idiopathic Nephrotic Syndrome: A Single-Center Experience in Japan. J Pediatr 2023; 254:11-16.e1. [PMID: 36223870 DOI: 10.1016/j.jpeds.2022.10.005] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/21/2022] [Revised: 08/30/2022] [Accepted: 10/05/2022] [Indexed: 11/05/2022]
Abstract
OBJECTIVE We studied infection rates and risk factors for infection in current patients with idiopathic nephrotic syndrome (INS). STUDY DESIGN This retrospective cohort study included the clinical data for children with diagnosed INS in our center between January 2010 and December 2020. The infection rates and risk factors were analyzed. RESULTS We enrolled 187 patients, including 85 cases with steroid-dependent/frequently relapsing nephrotic syndrome and 45 with steroid-resistant nephrotic syndrome. Infection was observed a total of 84 times in 55 patients (95.5 per 1000 person-years). Pneumonia was the most common infection (21 cases, 23.9 per 1000 person-years), followed by febrile neutropenia (12 cases, 13.7 per 1000 person-years), whereas peritonitis and bacteremia were observed in only 3 and 2 cases, respectively. The multivariate analyses by logistic regression showed that rituximab treatment was significantly associated with infections in pediatric INS (P = .001). The infection rate during the B-cell-depleted state with immunosuppressants (318 per 1000 person-years) was greater than that with normal B-cell count with immunosuppressants (109 per 1000 person-years) or without immunosuppressants (76 per 1000 person-years). CONCLUSION Common infections, such as peritonitis and bacteremia, decreased, whereas infections associated with medication (eg, rituximab) increased. The rate of infection increases during B-cell depletion after treatments with rituximab and other immunosuppressants.
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Affiliation(s)
- Hiroyuki Takao
- Center for Postgraduate Education and Training, National Center for Child Health and Development, Tokyo, Japan
| | - Kentaro Nishi
- Division of Nephrology and Rheumatology, National Center for Child Health and Development, Tokyo, Japan.
| | - Takanori Funaki
- Division of Infectious Diseases, National Center for Child Health and Development, Tokyo, Japan
| | - Yuta Inoki
- Division of Nephrology and Rheumatology, National Center for Child Health and Development, Tokyo, Japan
| | - Kei Osaka
- Division of Nephrology and Rheumatology, National Center for Child Health and Development, Tokyo, Japan
| | - Taishi Nada
- Division of Nephrology and Rheumatology, National Center for Child Health and Development, Tokyo, Japan; Department of Pediatrics, Yokohama City University Medical Center, Kanagawa, Japan
| | - Shunsuke Yokota
- Division of Nephrology and Rheumatology, National Center for Child Health and Development, Tokyo, Japan
| | - Mai Sato
- Division of Nephrology and Rheumatology, National Center for Child Health and Development, Tokyo, Japan
| | - Masao Ogura
- Division of Nephrology and Rheumatology, National Center for Child Health and Development, Tokyo, Japan
| | - Kenji Ishikura
- Department of Pediatrics, Kitasato University School of Medicine, Kanagawa, Japan
| | - Akira Ishiguro
- Center for Postgraduate Education and Training, National Center for Child Health and Development, Tokyo, Japan
| | - Koichi Kamei
- Division of Nephrology and Rheumatology, National Center for Child Health and Development, Tokyo, Japan
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Lin L, Li L, Cao Y, Peng X, Wu Y, Yu P, Dong L. The expression of respiratory tract virus in pediatric glomerular disease: a retrospective study of 45 renal biopsy in China. BMC Nephrol 2023; 24:36. [PMID: 36792980 PMCID: PMC9931563 DOI: 10.1186/s12882-023-03083-8] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/23/2022] [Accepted: 02/08/2023] [Indexed: 02/17/2023] Open
Abstract
BACKGROUND More attention has been put on the relationship between pediatric glomerular disease and respiratory tract virus infection. Children with glomerular illness, however, are uncommonly found to have biopsy-proven pathological evidence of viral infection. The purpose of this study is to determine whether and what kind of respiratory viruses are found in renal biopsy from glomerular disorders. METHODS We used a multiplex PCR to identify a wide range of respiratory tract viruses in the renal biopsy samples (n = 45) from children with glomerular disorders and a specific PCR to verify their expression. RESULTS These case series included 45 of 47 renal biopsy specimens, with 37.8% of male and 62.2% of female patients. Indications for a kidney biopsy were present in all of the individuals. In 80% of the samples, respiratory syncytial virus was discovered. Following that, the RSV subtypes in several pediatric renal disorders were found. There were 16 RSVA positives, 5 RSVB positives, and 15 RSVA/B positives, accounting for 44.4%, 13.9%, and 41.7%, respectively. Nephrotic syndrome samples made up 62.5% of RSVA positive specimens. The RSVA/B-positive was detected in all pathological histological types. CONCLUSIONS Patients with glomerular disease exhibit respiratory tract viral expression in the renal tissues, especially respiratory syncytial virus. This research offers new information on the detection of respiratory tract viruses in renal tissue, which may facilitate the identification and treatment of pediatric glomerular diseases.
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Affiliation(s)
- Li Lin
- grid.461863.e0000 0004 1757 9397Department of Pediatrics, West China Second University Hospital, Sichuan University, No. 20, Section 3, South Renmin Road, Chengdu, 610041 Sichuan Province China
| | - Lu Li
- grid.13291.380000 0001 0807 1581National Center for Birth Defect Monitoring, West China Second University Hospital, Sichuan University, No. 17, Section 3, South Renmin Road, Chengdu, 610041 Sichuan Province China ,grid.419897.a0000 0004 0369 313XKey Laboratory of Birth Defects and Related Diseases of Women and Children (Sichuan University), Ministry of Education, No. 17, Section 3, South Renmin Road, Chengdu, 610041 Sichuan Province China
| | - Yao Cao
- grid.461863.e0000 0004 1757 9397Department of Pediatrics, West China Second University Hospital, Sichuan University, No. 20, Section 3, South Renmin Road, Chengdu, 610041 Sichuan Province China
| | - Xin Peng
- grid.461863.e0000 0004 1757 9397Department of Pediatrics, West China Second University Hospital, Sichuan University, No. 20, Section 3, South Renmin Road, Chengdu, 610041 Sichuan Province China
| | - Yi Wu
- grid.461863.e0000 0004 1757 9397Department of Pediatrics, West China Second University Hospital, Sichuan University, No. 20, Section 3, South Renmin Road, Chengdu, 610041 Sichuan Province China
| | - Ping Yu
- National Center for Birth Defect Monitoring, West China Second University Hospital, Sichuan University, No. 17, Section 3, South Renmin Road, Chengdu, 610041, Sichuan Province, China. .,Key Laboratory of Birth Defects and Related Diseases of Women and Children (Sichuan University), Ministry of Education, No. 17, Section 3, South Renmin Road, Chengdu, 610041, Sichuan Province, China.
| | - LiQun Dong
- Department of Pediatrics, West China Second University Hospital, Sichuan University, No. 20, Section 3, South Renmin Road, Chengdu, 610041, Sichuan Province, China.
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Dávila-Collado R, Jarquín-Durán O, Solís-Vallejo A, Nguyen MA, Espinoza JL. Elevated Monocyte to Lymphocyte Ratio and Increased Mortality among Patients with Chronic Kidney Disease Hospitalized for COVID-19. J Pers Med 2021; 11:224. [PMID: 33809858 PMCID: PMC8004261 DOI: 10.3390/jpm11030224] [Citation(s) in RCA: 10] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/28/2021] [Revised: 03/10/2021] [Accepted: 03/18/2021] [Indexed: 01/08/2023] Open
Abstract
Chronic kidney disease (CKD) constitutes a major health problem and one of the leading causes of death worldwide. Patients with CKD have impaired immune functions that predispose them to an increased risk of infections, as well as virus-associated cancers and a diminished vaccine response. In this study, we aimed to identify clinical and laboratory parameters associated with in-hospital mortality in patients evaluated in the department of emergency (ER) and admitted with the diagnosis of severe acute respiratory syndrome (SARS) caused by coronavirus disease 2019 (COVID-19) at the Baptist Hospital of Nicaragua (BHN). There were 37 patients with CKD, mean age 58.3 ± 14.1 years, admitted to BHN due to COVID-19, and among them, 24 (65.7%) were males (p = 0.016). During hospitalization, 23 patients with CKD (62.1%) died of complications associated with COVID-19 disease, which was a higher proportion (odds ratio (OR) 5.6, confidence interval (CI) 2.1-15.7, p = 0.001) compared to a group of 70 patients (64.8% males, mean age 57.5 ± 13.7 years) without CKD admitted during the same period in whom 28.5% died of COVID-19. In the entire cohort, the majority of patients presented with bilateral pneumonia, and the most common symptoms at admission were dyspnea, cough, and fever. Serum levels of D-dimer, ferritin and procalcitonin were significantly higher in patients with CKD compared with those without CKD. Multivariate analysis revealed that CKD, age (>60 years), and hypoxia measured in the ER were factors associated with increased in-hospital mortality. Among patients with CKD but not in those without CKD (OR 36.8, CI 1.5-88.3, p = 0.026), an increased monocytes-to-lymphocyte ratio (MLR) was associated with higher mortality and remained statistically significant after adjusting for confounders. The MLR measured in the ER may be useful for predicting in-hospital mortality in patients with CKD and COVID-19 and could contribute to early risk stratification in this group.
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Affiliation(s)
- Ramsés Dávila-Collado
- Department of Emergency Medicine, Baptist Hospital of Nicaragua, Managua 11001, Nicaragua; (R.D.-C.); (O.J.-D.); (A.S.-V.)
| | - Oscar Jarquín-Durán
- Department of Emergency Medicine, Baptist Hospital of Nicaragua, Managua 11001, Nicaragua; (R.D.-C.); (O.J.-D.); (A.S.-V.)
| | - Andrés Solís-Vallejo
- Department of Emergency Medicine, Baptist Hospital of Nicaragua, Managua 11001, Nicaragua; (R.D.-C.); (O.J.-D.); (A.S.-V.)
| | - Mai Anh Nguyen
- Department of Hematology and Respirology, Kanazawa University, Kanazawa 920-0942, Japan;
| | - J. Luis Espinoza
- Faculty of Health Sciences, Kanazawa University, Kanazawa 920-0942, Japan
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