Association of infections and venous thromboembolism in hospitalized children with nephrotic syndrome
Nephrotic syndrome (NS) results in hypercoagulability and increased risk of infection. Furthermore, infection increases the risk of venous thromboembolism (VTE). Our objective was to determine the prevalence of infection, VTE, and the associated outcomes among a cohort of hospitalized children with NS.
All children with NS admitted to 17 pediatric hospitals across North America from 2010 to 2012 were included. Prevalence of infection and VTE was determined. Wilcoxon rank-sum and logistic regression were performed.
Seven-hundred thirty hospitalizations occurred among 370 children with NS. One-hundred forty-eight children (40%) had ≥ 1 infection (211 episodes) and 11 (3%) had VTE. Those with VTE had infection more frequently (p = 0.046) and were younger at NS diagnosis (3.0 vs. 4.0 years; p = 0.008). The most common infectious pathogen identified was Streptococcus pneumoniae. The median hospital length of stay for those with infection [10 vs 5 days (p < 0.0001)] or VTE [22 vs 6 days (p < 0.0001)] was longer than those without either complication. Of those with infection, 13% had an intensive care unit (ICU) stay compared with 3.3% of those without infection. Median ICU stay was 4 days in those with VTE compared to 0 days in those without (p < 0.001). By logistic regression, only the number of ICU days was associated with VTE (OR 1.074, 95% CI 1.013–1.138).
Hospitalized children with NS have high rates of infection. Presence of VTE was associated with infection. Both were associated with longer hospitalizations and ICU stays.
KeywordsNephrotic syndrome Infection Venous thromboembolism Focal segmental glomerulosclerosis Minimal change disease Infection
Compliance with ethical standards
The Institutional Review Board at each institution approved the study.
Conflict of interest
The authors declare that they have no conflict of interest.
- 6.Eneman B, Freson K, van den Heuvel L, van Hoyweghen E, Collard L, Vande Walle J, van Geet C, Levtchenko E (2015) Pituitary adenylate cyclase-activating polypeptide deficiency associated with increased platelet count and aggregability in nephrotic syndrome. J Thromb Haemost 13:755–767CrossRefGoogle Scholar
- 18.Rheault MN, Zhang L, Selewski DT, Kallash M, Tran CL, Seamon M, Katsoufis C, Ashoor I, Hernandez J, Supe-Markovina K, D’Alessandri-Silva C, DeJesus-Gonzalez N, Vasylyeva TL, Formeck C, Woll C, Gbadegesin R, Geier P, Devarajan P, Carpenter SL, Kerlin BA, Smoyer WE, Midwest Pediatric Nephrology Consortium (2015) AKI in children hospitalized with nephrotic syndrome. Clin J Am Soc Nephrol 10:2110–2118CrossRefGoogle Scholar
- 19.Robinson CL, Romero JR, Kempe A, Pellegrini C, Advisory Committee on Immunization Practices Child/Adolescent Immunization Work G (2017) Advisory committee on immunization practices recommended immunization schedule for children and adolescents aged 18 years or younger - United States, 2017. MMWR Morb Mortal Wkly Rep 66:134–135CrossRefGoogle Scholar
- 26.Carpenter SL, Goldman JL, Sherman AK, Bell JJ, Selvaraju S, Selvarangan R (2012) Staphylococcus aureus virulence factors surface-associated adhesion (sdrD) and fibronectin-binding protein B (fnbB) associated with deep-vein thrombosis in pediatric patients. Am J Hematol 87:S147Google Scholar