Risk factors associated with relapse and hospitalization during periods of febrile infection in children with nephrotic syndrome treated with immunosuppressant

Abstract

Patients with idiopathic nephrotic syndrome (NS) receiving immunosuppressant often present with febrile infection, leading to a relapse of NS and/or hospitalization. We retrospectively studied a cohort compromising 83 children diagnosed with NS (203 cases of febrile infection) who were administered immunosuppressant between 2005 and 2016. We found that 15 patients (7.4%) presented with a relapse of NS associated with febrile infection. In patients presenting with a relapse use of mycophenolate mofetil (MMF) was significantly lower compared to those without a relapse (p<0.01). Mizoribine (MZR) use and mortality rate of influenza were significantly higher in patients showing a relapse compared to those without a relapse (p<0.05). Hospitalization was required in 15 patients (7.4%) and two of them developed a serious influenza infection. Among hospitalized patients, age at the onset of febrile infection and use of cyclosporine A were significantly lower compared to these parameters in non-hospitalized patients (p<0.05). MMF use was significantly higher in hospitalized patients compared to non-hospitalized ones (p<0.05). Our study found that MMF may be superior to high-dose-MZR to prevent relapsing NS associated with a febrile infection. However, MMF may be a risk factor for hospitalization at the time of febrile infection.