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Pediatric Nephrology

, Volume 34, Issue 2, pp 261–267 | Cite as

Association of infections and venous thromboembolism in hospitalized children with nephrotic syndrome

  • Shannon L. Carpenter
  • Jennifer Goldman
  • Ashley K. Sherman
  • David T. Selewski
  • Mahmoud Kallash
  • Cheryl L. Tran
  • Meredith Seamon
  • Chryso Katsoufis
  • Isa Ashoor
  • Joel Hernandez
  • Katarina Supe-Markovina
  • Cynthia D’alessandri-Silva
  • Nilka DeJesus-Gonzalez
  • Tetyana L. Vasylyeva
  • Cassandra Formeck
  • Christopher Woll
  • Rasheed Gbadegesin
  • Pavel Geier
  • Prasad Devarajan
  • William E. Smoyer
  • Bryce A. Kerlin
  • Michelle N. RheaultEmail author
Original Article

Abstract

Background

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.

Methods

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.

Results

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).

Conclusions

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.

Keywords

Nephrotic syndrome Infection Venous thromboembolism Focal segmental glomerulosclerosis Minimal change disease Infection 

Notes

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.

Supplementary material

467_2018_4072_MOESM1_ESM.docx (14 kb)
ESM 1 (DOCX 14 kb)
467_2018_4072_MOESM2_ESM.docx (15 kb)
ESM 2 (DOCX 14 kb)

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Copyright information

© IPNA 2018

Authors and Affiliations

  • Shannon L. Carpenter
    • 1
  • Jennifer Goldman
    • 1
  • Ashley K. Sherman
    • 1
  • David T. Selewski
    • 2
  • Mahmoud Kallash
    • 3
  • Cheryl L. Tran
    • 4
  • Meredith Seamon
    • 5
  • Chryso Katsoufis
    • 6
  • Isa Ashoor
    • 7
  • Joel Hernandez
    • 8
  • Katarina Supe-Markovina
    • 9
  • Cynthia D’alessandri-Silva
    • 10
  • Nilka DeJesus-Gonzalez
    • 11
  • Tetyana L. Vasylyeva
    • 12
  • Cassandra Formeck
    • 13
  • Christopher Woll
    • 14
  • Rasheed Gbadegesin
    • 15
  • Pavel Geier
    • 16
  • Prasad Devarajan
    • 17
  • William E. Smoyer
    • 3
  • Bryce A. Kerlin
    • 3
  • Michelle N. Rheault
    • 18
    • 19
    Email author
  1. 1.Children’s Mercy HospitalKansas CityUSA
  2. 2.University of MichiganAnn ArborUSA
  3. 3.Nationwide Children’s HospitalColumbusUSA
  4. 4.Mayo ClinicRochesterUSA
  5. 5.University of UtahSalt Lake CityUSA
  6. 6.University of Miami Miller School of MedicineMiamiUSA
  7. 7.LSU Health Sciences CenterNew OrleansUSA
  8. 8.Kaiser PermanenteLos AngelesUSA
  9. 9.Stony Brook Children’s HospitalStony BrookUSA
  10. 10.Connecticut Children’s HospitalHartfordUSA
  11. 11.University of Puerto RicoSan JuanPuerto Rico
  12. 12.Texas Tech University Health Sciences CenterAmarilloUSA
  13. 13.Children’s Hospital of Pittsburgh of UPMCPittsburghUSA
  14. 14.Yale School of MedicineNew HavenUSA
  15. 15.Duke UniversityDurhamUSA
  16. 16.Children’s Hospital of Eastern OntarioOttawaUSA
  17. 17.Cincinnati Children’s Hospital Medical CenterCincinnatiUSA
  18. 18.University of Minnesota Masonic Children’s HospitalMinneapolisUSA
  19. 19.Division of Pediatric NephrologyUniversity of MinnesotaMinneapolisUSA

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