Immunosuppressive treatment patients with idiopathic minimal change nephrotic syndrome (MCNS) are vulnerable to infection consequences. There needed to be more research that focused primarily on infectious problems in the adult population.

A total of 101 adult patients with biopsy-proven idiopathic MCNS were retrospectively collected, and the infectious complications were examined. Additionally, published literature was examined to assess the viability of preventive antibiotic therapy.

With pneumonia (n = 4), cellulitis/fasciitis (n = 4), and urinary tract infection (UTI) (n = 4) as the most common infections and Gram-negative bacilli as the primary cause, infectious complications emerged in 17 of 101 (16.8%) of the patients. The two independent risk variables for developing infectious complications were AKI stage ≥2 (Hazard ratio = 6.1; 95% CI: 1.2-31.9, P = 0.031) and non-remission by therapy (Hazard ratio = 4.4; 95% CI: 1.2-15.6, P =.023). Even without preventive antibiotic therapy, only one incidence of Pneumocystis jirovecii pneumonia emerged among the 1,787 cumulative cases of MCNS, according to a review of 16 published literature and the data. In contrast, among the 36 patients with positive hepatitis B surface antigens who did not receive antiviral preventive medication, 16 (44%) acute flare episodes were observed.

In adult MCNS receiving immunosuppressive medication, advanced acute kidney damage and lack of remission after treatment are risk factors for developing infectious complications. While screening and preventive treatment for hepatitis B and latent TB are crucial for individuals in high-prevalence areas, it seemed unnecessary to use prophylactic antibiotics for Pneumocystis jiroveci pneumonia or other bacterial diseases.

Reference: onlinelibrary.wiley.com/doi/10.1111/nep.14119