title: Risk of Nephrotic Syndrome following Enteroviral Infection in Children: A Nationwide Retrospective Cohort Study.
abstract: OBJECTIVE
  Nephrotic syndrome is a common chronic illness encountered during childhood. Infections have been identified as a cause of nephrotic syndrome. The aim of this study was to evaluate the association between enteroviral infection and nephrotic syndrome.
  
  
  METHODS
  A nationwide retrospective cohort study was conducted by analyzing data from the National Health Insurance Research Database in Taiwan. Children aged <18 years with enteroviral infection were enrolled. Non-enterovirus-infected children were randomly selected as the comparison cohort. The primary endpoint was the occurrence of nephrotic syndrome.
  
  
  METHODS
  This study included 280,087 enterovirus-infected children and 280,085 non-enterovirus-infected children. The mean age of the enterovirus-infected children was 2.38 years, and 53.7% of these children were boys. The overall incidence densities of nephrotic syndrome for enterovirus- and non-enterovirus-infected children were 2.65 and 2.21 per 10,000 person-years, respectively. The enterovirus-infected cohort had a higher cumulative incidence of nephrotic syndrome than did the non-enterovirus-infected cohort (log-rank test, p = 0.01). Multivariable analyses revealed that children with enteroviral infection were significantly associated with an increased risk of nephrotic syndrome compared with those without enteroviral infection (adjusted hazard ratio, 1.20; 95% confidence interval, 1.04-1.39; p = 0.01), particularly in children infected with coxsackievirus. Subgroup analyses revealed that enterovirus-infected girls, children of blue-collar workers, and children without allergies had a higher risk of nephrotic syndrome than did children in the non-enterovirus-infected cohort.
  
  
  CONCLUSIONS
  This study revealed a significant association between enteroviral infection and nephrotic syndrome. Additional studies elucidating the role and pathogenesis of enterovirus in nephrotic syndrome are warranted.
authors: Department of Critical Care Medicine, E-Da Hospital, I-Shou University, Kaohsiung, Taiwan.|School of Medicine, College of Medicine, I-Shou University, Kaohsiung, Taiwan.|Division of Infectious Diseases, Department of Internal Medicine, E-Da Hospital, I-Shou University, Kaohsiung, Taiwan.
authors: Jiun-Nong
authors: JN
authors: Lin
authors: Management Office for Health Data, China Medical University Hospital, Taichung, Taiwan.|College of Medicine, China Medical University, Taichung, Taiwan.
authors: Cheng-Li
authors: CL
authors: Lin
authors: General Education Center, Meiho University, Pingtung, Taiwan.
authors: Chi-Hui
authors: CH
authors: Yang
authors: Department of Nuclear Medicine, E-Da Hospital, I-Shou University, Kaohsiung, Taiwan.
authors: Ming-Chia
authors: MC
authors: Lin
authors: Division of Infectious Diseases, Department of Internal Medicine, E-Da Hospital, I-Shou University, Kaohsiung, Taiwan.
authors: Chung-Hsu
authors: CH
authors: Lai
authors: Division of Infectious Diseases, Department of Internal Medicine, E-Da Hospital, I-Shou University, Kaohsiung, Taiwan.
authors: Hsi-Hsun
authors: HH
authors: Lin
authors: Graduate Institute of Clinical Medical Science and School of Medicine, College of Medicine, China Medical University, Taichung, Taiwan.|Department of Nuclear Medicine and PET Center, China Medical University Hospital, Taichung, Taiwan.|Department of Bioinformatics and Medical Engineering, Asia University, Taichung, Taiwan.
authors: Chia-Hung
authors: CH
authors: Kao
mesh_terms: D002648:Child; D002675:Child, Preschool; D015331:Cohort Studies; D015897:Comorbidity; D004769:Enterovirus Infections / Q000150:complications* / Q000453:epidemiology; D005260:Female; D006801:Humans; D007223:Infant; D053208:Kaplan-Meier Estimate; D008297:Male; D009404:Nephrotic Syndrome / Q000453:epidemiology* / Q000209:etiology*; D016016:Proportional Hazards Models; D012189:Retrospective Studies; D012959:Socioeconomic Factors; D013624:Taiwan / Q000453:epidemiology