| Background:Nephrotic Syndrome(NS)patients are at high risk of tuberculosis(TB)infection due to their own body dysfunction and immunosuppressant and hormone use;TB infection affects the efficacy of nephrotic disease and easily leads to recurrence of nephrotic disease,increasing the risk of progression to Chronic kidney disease(CKD)in nephrotic patients.TB infection affects the efficacy of kidney disease and is likely to lead to recurrence of kidney disease,increasing the risk of progression to Chronic kidney disease(CKD)and thus increasing hospitalisation and mortality rates.The benefits of prophylactic anti-tuberculosis treatment for patients with NS co-infection(LTBI)have rarely been reported.Objective:1 To investigate the clinical characteristics and prognosis of NS combined with active TB infection through retrospective cases,and to analyse the risk factors affecting the prognosis of active TB combined with NS;to provide a reference basis for the diagnosis and treatment of these patients in clinical practice;2 Compare the treatment effect and side effects of NS combined with LTBI infection with and without prophylactic anti-tuberculosis treatment,and analyse the risk factors for LTBI activity;provide guidance for the prophylactic use of drugs in clinical practice.Methods:This study was a single-centre,retrospective cohort study.All patients with NS combined with TB infection who met the inclusion exclusion criteria in our hospital from January 2012 to June 2022 were enrolled and their clinical case data were analyzed1.Patients eligible for NS combined with active TB were enrolled in the study.Demographic data,co-morbidities,clinical laboratory indicators and NS drug use were collected,basic clinical characteristics were analysed and patients were followed up until the endpoint event was reached.The primary endpoint event was defined: patients achieved NS remission(including complete and partial remission);secondary endpoint events were defined:(1)patients’ blood Cr levels doubled from baseline values or entered ESRD or required renal replacement therapy;(2)Death was the endpoint event,and univariate and multifactor COX regressions were performed according to whether the patient reached the endpoint event,and the influencing factors were analysed.2.Include all patients with LTBI combined with NS using immunosuppressive drugs who meet the inclusion exclusion criteria at our institution from January 2019 to June 2022,collect demographic data,co-morbidities,clinical laboratory indicators,NS drug use,side effects and use of prophylactic anti-tuberculosis treatment,and form a control between patients using prophylactic anti-tuberculosis treatment and those not using prophylactic anti-tuberculosis;A 1:1 propensity score matching(PSM)was performed to compare baseline information after the PSM,and patients were followed up until the endpoint event was reached.NS endpoint event was defined as patients achieving NS remission(including complete and partial remission);LTBI endpoint event was defined as LTBI progression to active TB,and univariate and multifactorial COX regression analyses were performed according to whether patients reached the endpoint event,and analysis of influencing factors.Results:I.104 patients with NS combined with active TB infection were included in this study: 1 case was lost to follow-up1.The clinical baseline data of 104 patients were counted: predominantly male(78.85%);mostly comorbid(66.35%);predominant pathological type membranous nephropathy(54.28%),predominant tuberculosis type pulmonary tuberculosis,atypical clinical and imaging manifestations,and high side effects of anti-tuberculosis drugs(17.47%).2.103 patients were analysed at follow-up: 38 patients(36.89%)achieved remission(including complete and partial remission);comparison of baseline data between the remission and non-remission groups showed that: Cr,BUN,C4,24-hour urine protein quantification and age were significantly higher in the non-remission group than in the remission group,and e GFR,Alb and Hb were significantly lower than in the remission group,and they were mostly combined with diabetes and hypertension.Multi-factor COX regression analysis suggested combined hypertension(HR=0.263,95% CI: 0.096-0.716,P=0.009),CRP(HR=0.977,95% CI:0.955-1.000,P=0.001),WBC(HR=0.718,95% CI: 0.544-0.948,P= 0.022),neutrophils 0.688(HR=0.688,95% CI: 0.521-0.910,P=0.009),and 24-hour urine protein quantification(HR=0.798,95% CI: 0.661-0.963,P=0.019)were independent risk factors for NS remission;Hb(HR=1.071,95% CI: 1.037-1.106,P=0.019)was a protective factor for NS remission.37 patients(35.92%)achieved doubling of blood Cr levels from baseline and entered ESRD or required renal replacement therapy;NS remission(HR=0.227,95% CI: 0.075-0.685,P=0.009),PLT levels(HR= 0.994,95%CI: 0.989-0.998,P=0.009)reduced the risk of patients’ blood Cr levels doubling from baseline values or entering ESRD or requiring renal replacement therapy,with BUN(HR=1.120,95% CI: 1.037-1.208,P=0.004)being an independent risk factor.12 patients died(11.65%);age(HR=1.128,95% CI: 1.047-1.216,P=0.002),Cr(HR=1.008,95% CI: 1.001-1.016,P=0.022),membranous nephropathy(HR=6.239,95% CI: 0.663-58.712,P=0.010)were patients independent risk factor for death and Alb(HR=0.833,95% CI: 0.724-0.958,P=0.010)was a protective factor.II.142 patients with NS combined with LTBI were included;matched on a 1:1propensity score(PSM),74 cases were finally included,37 in the group using prophylactic anti-TB treatment and 37 in the group not using prophylactic anti-TB treatment,with no statistically significant baseline characteristics in either group(P>0.05)and no statistically significant difference in NS remission rates between the two groups at the end of follow-up,and in the group receiving prophylactic treatment There was no statistically significant difference in side effects between the two groups(P=0.238 > 0.050);six patients in the non-preventive group developed active TB,all of whom had pulmonary TB,and no active TB was found in the preventive group.Kaplan-Meier method estimates comparing the cumulative survival rate of LTBI in the preventive and non-preventive groups were statistically significant between the two groups(P=0.029<0.050);COX regression analysis was performed on six patients with active LTBI: follow-up time 11.00(9.75-14.00),age,diabetes,CRP,ESR,monocytes were statistically significant in the univariate COX analysis(P<0.05),and the above significant variables were included in the multivariate COX analysis: diabetes,age,CRP,monocytes were included Diabetes(HR=17.086,95%CI: 1.107-263.694,P=0.042)and CRP(HR=1.073,95% CI: 1.009-1.141,P=0.025)were risk factors for LTBI activity in the monocyte,CRP,and hormone therapy alone models.Conclusions:1.In patients with NS combined with active TB infection: clinical features are prevalent in middle-aged and elderly males;pathological types are mostly membranous nephropathy,with pulmonary TB common,and atypical clinical symptoms and imaging.The prognosis is poor,with a high incidence of adverse drug reactions(17.47%);the overall remission rate of NS is low(36.89%);PLT and BUN levels are independent risk factors for doubling the baseline value of blood Cr levels or entering ESRD or requiring renal replacement therapy;mortality is high(11.65%),and membranous nephropathy,advanced age,Cr and Alb levels are independent risk factors for death.The risk of mortality was high(11.65%),and membranous nephropathy,advanced age,Cr and Alb levels were independent risk factors for death.2.Patients with NS combined with LTBI: The rate of overall remission was higher in NS than in NS combined with active TB;prophylactic anti-TB treatment significantly reduced LTBI activity,and TB drug side effects were not significantly different and were manageable.Co-morbid diabetes and CRP levels are independent risk factors for LTBI activity.Early prophylactic treatment is recommended for patients with NS combined with LTBI. |
