Marcadores sorológicos de infecções em crianças e adolescentes com síndrome nefrótica : casuística de um serviço de referência do estado de Mato Grosso, Brasil.

Abstract

This sectional study was performed in order to describe the prevalence of seruma markers of infections by HIV, hepatites B (HBV) and (HCV) viroses, cytomegalovirus (CMV), herpes simplex virus (HSV), Treponema pallidum and Toxoplasma gondii in children and teenagers with nephrotic syndrome (NS) from a reference service of Mato Grosso State, Central Brazil. Analysis of the patients’ follow up was performed to get a better understanding of the role of these agents in the genesis and evolution of NS. This service started in 1993 and has searched for markers of these infections since then. More recently all tests are performed by ELISA. 169 patients were included. 103 were male (60.9%) and median age at the beginning was 44 months. The median of follow up was 43 months. Renal biopsy was performed in 48.5% of them and minimal change glomerulonephritis (47.6%) and local focal glomerulosclerosis (30.5%) were the commoner features. Only two patients were not treated with corticosteroids. Class IgG antibodies against CMV and T. gondii were the most frequent (70.4% and 32.5%), respectively). Class IgM antibodies against CMV and T. gondii were present in 4.1% and 5.3%, respectively. Two female patients were positive for HBV surface antigen, but none presented positivity for HIV, HCV or T. pallidum. 54 patients underwent tests for HSV and 48.1% and 22.2% were positive for IgG and IgM, respectively. Treatment against toxoplasmosis, CMV and HSV were performed in 18, two and four patients, respectively. All of them needed corticosteroids later. Seven patients who were treated against toxoplasmosis had the sensibility to corticosteroids reestablished. 9 IgG class antibodies against T. gondii, CMV e HSV were common among these children and teenagers. IgM class antibodies, suggesting recent or active infection were shown, such as in a subgroup tested for HSV. Few patients presented clinical findings attributable to acute infection by T. gondii, CMV or HSV, suggesting a possible role of these agents in the genesis of NS or that they have worked as a trigger factor. Although HIV, HCV and T. pallidum are known as causes of NS, they did not seem to have epidemiologic importance in this population. In the same way, HBV should be actually a rare cause of NS because the decrease of incidence in Brazilian children. The two cases detected in this group were followed up in the 90’s before the regular immunization of children in Brazil.