An implication of relationship between tuberculosis and primary nephrotic syndrome.

OBJECTIVE

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.