Afroz S, Roy D K, Khan A H
Department of Paediatric Nephrology, Dhaka Medical College & Hospital, Dhaka, Bangladesh.
Mymensingh Med J. 2013 Apr;22(2):336-41.
Low serum level of IgG, complement C3 and C4 in nephrotic syndrome children may cause increased susceptibility to infection. Serum level of IgG and complements in nephrotic children (NS) with UTI has been analyzed in this cross sectional study. It was carried out in the department of Pediatric nephrology, National Institute of Kidney Diseases & Urology (NIKDU), Dhaka, Bangladesh. The study subjects were followed up prospectively for one year to see and compare the frequency of relapse of NS and UTI. Patients were selected in a nonrandom purposive technique. Nephrotic syndrome children with initial attack between 1-12 year of age were included over a period of one year. The patients were grouped into Group I - UTI positive and Group II - UTI negative depending on urine culture positivity and colony count >10⁵ CFU/ml. Serum IgG and complements C3, C4 levels were done in both groups during nephrosis and were compared. A total of 101 children M: F 1.7:1, mean age 5.96±3.2 years were included in this study. Group I, n=45 vs. Group II, n=56. The mean serum level of IgG was low in Group I (549.91±210.71 vs. 728.64±235.81mg/dl, p<0.001). Serum IgG level less than 700mg/dl was found in 37 vs. 23 children {x² (¹) 17.52 p<0.001, OR=6.63}. Mean serum complement C3 level was also low in Group I (123.09±40.52 vs. 143.38±37.06mg/dl, p<0.05). But complement C3 and C4 level do not carry any risk of developing UTI in nephrotic children. Higher number of children in Group II were at remission (n=24) during follow up, while frequent relapsers were high in Group I (n=22). Increased frequency of UTI attack (88 episodes) was found in Group I children compared to none in Group II during follow up. So low serum level of IgG in children with NS during nephrosis can predict UTI with an odds ratio of 6.63 as well as relapse. Serum level of C3, C4 do not associated with any risk of development of UTI in NS children.
肾病综合征患儿血清IgG、补体C3和C4水平较低可能导致其感染易感性增加。本横断面研究分析了患有泌尿道感染（UTI）的肾病患儿（NS）的血清IgG和补体水平。该研究在孟加拉国达卡国立肾脏疾病与泌尿外科研究所（NIKDU）的儿科肾脏病科进行。对研究对象进行了为期一年的前瞻性随访，以观察和比较肾病综合征和泌尿道感染的复发频率。采用非随机目的抽样技术选取患者。纳入了1至12岁首次发病的肾病综合征患儿，为期一年。根据尿培养阳性和菌落计数>10⁵CFU/ml，将患者分为I组 - UTI阳性和II组 - UTI阴性。在肾病期间对两组患者进行血清IgG和补体C3、C4水平检测并比较。本研究共纳入101名儿童，男女比例为1.7:1，平均年龄5.96±3.2岁。I组45例，II组56例。I组的平均血清IgG水平较低（549.91±210.71 vs. 728.64±235.81mg/dl，p<0.001）。37例患儿的血清IgG水平低于700mg/dl，而II组为23例{x²(¹)17.52 p<0.001，OR=6.63}。I组的平均血清补体C3水平也较低（123.09±40.52 vs. 143.38±37.06mg/dl，p<0.05）。但补体C3和C4水平与肾病患儿发生UTI的风险无关。随访期间，II组缓解的患儿数量较多（n=24），而I组频繁复发的患儿较多（n=22）。随访期间，I组患儿的UTI发作频率增加（88次发作），而II组无发作。因此，肾病期间肾病综合征患儿的低血清IgG水平可预测UTI，比值比为6.63，也可预测复发。补体C3、C4水平与肾病综合征患儿发生UTI的风险无关。
