title: Tuberculosis in childhood nephrotic syndrome in India.
abstract: We studied the prevalence, clinical features, and impact of tuberculosis (TB) on children with nephrotic syndrome (NS). Of the 300 children with NS, 28 (9.3%) were diagnosed as having TB. This occurred following the initiation of immunosuppressive therapy in 27 children, and in 1 child it preceded the onset of NS. Pulmonary involvement was the commonest (22/28), followed by tubercular lymphadenitis (2/28), meningitis (2/28), and occult TB (2/28). Of the various diagnostic criteria, history of previous cough, fever, or exposure to a case of TB (23/28) and chest skiagram (21/28) were the most useful. The occurrence of TB did not induce a relapse or affect the subsequent response to steroid therapy (as is often seen with other infections) or have a deleterious effect on renal function. Patients who received higher doses of steroids (frequent relapsers, steroid dependent, initial non-responders, and subsequent non-responders) had a significantly higher prevalence of TB (19/148) than those who received lower doses (infrequent relapsers 8/151) (P = 0.04). We thus found TB to be an important complication of children with NS in our country. The conventional diagnostic tests, such as Mantoux and acid-fast bacilli isolation, are often unhelpful in these children, and a high index of suspicion is required, especially in children who require frequent courses of steroid therapy.
authors.affiliation: Department of Nephrology, Sanjay Gandhi Post Graduate Institute of Medical Sciences, Lucknow, UP, India.
authors.forename: S
authors.initials: S
authors.lastname: Gulati
authors.forename: V
authors.initials: V
authors.lastname: Kher
authors.forename: K
authors.initials: K
authors.lastname: Gulati
authors.forename: P
authors.initials: P
authors.lastname: Arora
authors.forename: R
authors.initials: R
authors.lastname: Gujral
mesh_terms: D000293:Adolescent; D000893:Anti-Inflammatory Agents / Q000009:adverse effects / Q000627:therapeutic use; D002648:Child; D005260:Female; D006801:Humans; D007194:India / Q000453:epidemiology; D008297:Male; D009404:Nephrotic Syndrome / Q000150:complications* / Q000453:epidemiology / Q000503:physiopathology; D012008:Recurrence; D012189:Retrospective Studies; D013256:Steroids; D014376:Tuberculosis / Q000150:complications* / Q000453:epidemiology / Q000503:physiopathology
chemical_list: D000893:Anti-Inflammatory Agents; D013256:Steroids