Risk Factor of Tuberculosis in Children with Nephrotic Syndrome who Received Immunosuppressant Therapy in Hasan Sadikin Hospital

Abstract

Patients with nephrotic syndrome (NS) are in immunocompromised condition due to illness and therapy given. Treatment of NS with long-term steroids, high doses and combination with cyclophosphamide decreases body resistance. Immunocompromised conditions facilitate the occurrence of infection, one of the infections that might occur is tuberculosis (TB) with a high incidence in Indonesia. The aim of the study was to investigate the risk factors of TB in children with NS, specifically related to the duration of steroids administration, and combinations of steroids with cyclophosphamide. This was cross sectional study data retrieval from out-patients and in-patients NS children in RS Hasan Sadikin Bandung (RSHS) during 1st January 2012 until 31st December 2016. Statistical analysis using chi-square test and multiple logistic regression. There were 34 children with TB from 199 NS patients, the prevalence of TB in children with NS in RSHS (17%). The results showed that duration of steroids administration, combination of steroids and cyclophosphamide, female gender, and under nutrition were significant to tuberculosis incidence (p <0.001). Multiple logistic regression analysis revealed duration of steroid 175,5 days OR 20,7 (CI95% 7,5-68,1); p<0.001, combination of steroids with cyclophosphamide OR 3,2 (CI95% 1,1-11,7); p=0,027, female gender OR 2,5 (CI95% 0,9-7,2); p=0,077, and under nutrition OR 7,2 (CI95% 2,4-3,7); p=0.001. Duration of steroid administration, combination of steroids with cyclophosphamide, female gender, and under nutrition were risk factors for tuberculosis. The duration of steroid administration was the most dominant factor in the incidence of tuberculosis in children with NS.