TUBERCULOSIS IN CHILDHOOD NEPHROTIC SYNDROME IN INDIA

We studied the prevalence, clinical features, and impact of tuberculos is (TB) on children with nephrotic syndrome (NS). Of the 300 children with NS, 28 (9.3%) were diagnosed as having TB. This occurred followin g the initiation of immunosuppressive therapy in 27 children, and in 1 child it preceded the onset of NS. Pulmonary involvement was the comm onest (22/28), followed by tubercular lymphadenitis (2/28), meningitis (2/28), and occult TB (2/28). Of the various diagnostic criteria, his tory 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 the rapy (as is often seen with other infections) or have a deleterious ef fect on renal function. Patients who received higher doses of steroids (frequent relapsers, steroid dependent, initial non-responders, and s ubsequent non-responders) had a significantly higher prevalence of TB (19/148) than those who received lower doses (infrequent relapsers 8/1 51) (P = 0.04). We thus found TB to be an important complication of ch ildren with NS in our country. The conventional diagnostic tests, such as Mantoux and acid-fast bacilli isolation, are often unhelpful in th ese children, and a high index of suspicion is required, especially in children who require frequent courses of steroid therapy.