An implication of relationship between tuberculosis and primary nephrotic syndrome.

PURPOSE: There have been few observations on the concurrence of tuberculosis (TB) and primary nephrotic syndrome (PNS). We try to define their relationship from multiple aspects.

METHODS

Patients with PNS (n = 386), secondary nephrotic syndrome (SNS, n = 60), pneumonia (n = 196), and TB (n = 156) were enrolled. Through a novel evaluation system, the evidence of TB infection (clinical, laboratory, and radiographic evidence) was classified into 5 levels: lack of evidence (level 0), mild-to-moderate evidence (level 1-2), strong evidence (level 3-4). Additionally, whether TB infection was primary or secondary to long-term steroid therapy for PNS was recorded.

RESULTS

Through the evaluation system, 42.24% (68/161) of PNS inpatients had evidence of TB level 1-4, more than those in SNS (23.33%, P = .788) or pneumonia (22.45%, P = .004); 9.32% (15/161) PNS inpatients had evidence of level 3-4, who should be considered as having TB; 13 of the 15 patients had TB before the onset of PNS; 61.75%(96/153) PNS inpatients were abnormal on chest imaging. In the TB group, 28.21% (44/156) patients had abnormal urinalysis, more than those in the pneumonia group (8.16%, 16/196, P<0.001). TB-related symptoms were seldom seen in PNS inpatients (cough 26.1%, fever 6.8%; night sweats, fatigue, and weight loss were negative).

CONCLUSIONS

Around 10% of PNS in children has an association with TB infection that preceded the onset of PNS.