Risk Factors And Prognosis Of Infection In Patients With Chronic Glomerular Disease

BackgroundIn China,chronic kidney disease(CKD)and end stage renal disease(ESRD)bring huge burdens for the health care systems,the morbidity and prevalence rate are still increasing year by year.Infection is the most important complication of CKD,studies have proved that the morbidity and mortality rate of CKD patients are well above the normal population,and poor kidney function indicates a higher risk of infection and mortality.Chronic glomerular disease is an important part of CKD,and is also the most common cause of ESRD in our country.Because chronic glomerular disease usually needs glucocorticoid and/or immunosuppressant treatment,there is an additional risk of infection for these patients.Currently studies on the infection in chronic glomerular disease patients is limited,and numbers of studies focus on risk factors other than immunosuppressant are even few.Our study aims to investigate the risk of infection for chronic glomerular disease,especially for different types glomerular disease,and the impact of infection for prognosis of chronic glomerular disease.Objective1.Summarize the basic information about infection(for example,the infection rate over time,the location of infection,and infectious pathogens)of hospitalized patients with chronic glomerular disease in Peking Union Medical College Hospital(PUMCH),2012-2016.Compare the infection rate between different types of glomerular disease.2.Investigate the risk factors for infection through case-control study,compare the difference between different types of chronic glomerular disease.3.To study the impact of infection on the remission rate of proteinuria and decreased renal function of IgA nephropathy.MethodThe number of cases and trends over time of hospitalized infection and lung infection in PUMCH from Jan 1st,2000 to Dec 31st,2016 were tested by cross-sectional study.To analyze the cause of hospitalized infection in chronic glomerular disease patients in PUMCH from Jan 1st,2012 to Dec 31st,2016,including the location of infection,the type of pathogens,the distribution of infection in different types of glomerular disease,and compare the differences between lupus nephritis,idiopathic membranous nephropathy and IgA nephropathy.Using case-control study and multi factor Logistic regression model for the following analysis:(1)Compare the risk of hospitalized infection for different types of chronic glomerular disease.(2)Analyze whether there is an impact of hospitalized infection on the remission rate of proteinuria and decreased renal function in the process of IgA nephropathy treatment.Result1.There was a gradually increasing trend in the number of chronic glomerular disease patients with hospitalized infection during 2000 to 2016,after 2010 the trend increased faster than before.2.The total number of chronic glomerular disease patients with hospitalized infection diagnosed in PUMCH during 2012 to 2016 was 955.Lung was the most common location of infection(79.6%),followed by blood infection(8%)and urinary tract infection(5%).Bacterium was the most common infectious pathogen(38.8%),followed by virus(21.9%),fungus(17.6%),tuberculosis(18.1%)and PCP(14.2%).Among different types of CGN,lupus nephritis had the highest incidence of infection(32.1%),followed by idiopathic membranous nephropathy(12.1%)and IgA nephropathy(5.5%).3.One-way ANOVA analysis of different types of glomerular disease indicated that the incidence of skin and soft tissue infection was significantly higher in lupus nephritis patients compared with the other two types,the incidence of PCP infection was significantly higher in IgA nephropathy patients compared with the other two types.4.The risk of hospitalized infection of different types of chronic glomerular disease was different.Patients with lupus nephritis had the highest risk of hospitalized infeetion,the risk is 4 times higher than that of IgA nephropathy,followed by systemic vasculitis patients with renal involvement and patients with HSPN.5.After patients with IgA nephropathy got infection,the urine protein remission rate and the rate of eGFR decreased more than 30%baseline changes:single factor and gender,age adjusted logistic regression analysis indicated that infection was a risk factor for the decrease in urine protein remission rate and level of eGFR.Taken the confounding factors into regression analysis,the result showed that the impact of infection on the decrease in urine protein remission rate is not significant.Taken the whole process of treatment as correction factor,infection would increase the risk of eGFR reduction,but taken the plan of initial treatment as correction factor,the impact of infection for the reduction of eGFR was not significant.Conclusion1.The incidence of hospitalized infection for chronic glomerular disease patients in PUMCH was increasing year by year.The most common site of infection was lung,the most common infectious pathogen was bacterium,patients with lupus nephritis had the highest incidence of infection among all chronic glomerular diseases,followed by idiopathic membranous nephropathy and IgA nephropathy.2.Patients with lupus nephritis were at a higher risk of skin and soft tissue infection compared with the other two types of glomerular disease.Patients with IgA nephropathy were more likely to get PCP infection compared with the other two types.3.Among the common types of CGN,lupus nephritis,HSPN,and systemic vasculitis patients with renal involvement had a higher risk of hospitalized infection compared with IgA nephropathy,idiopathic membranous nephropathy and minimal change nephropathy.4.If patients with IgA nephropathy develops hospitalized infection,they are possibly at a risk of urine protein remission rate decrease and renal function reduction.