TOP 41 - Association of Community Respiratory Viral Infections with Pediatric Nephrotic Syndrome Relapse

Publication Number: 1800.TOP 41

Haley E. Moss, University of California, San Diego School of Medicine, El Cajon, CA, United States; Zaineb Boulil, Rady Children's Hospital San Diego, San Diego, CA, United States; Clarkson Crane, University of California, San Diego School of Medicine, San Diego, CA, United States; Alice Pong, University of California, San Diego School of Medicine, San Diego, CA, United States; Caitlin Carter, Rady Children's Hospital - - San Diego, CA, San Diego, CA, United States

Background: Idiopathic childhood nephrotic syndrome affects 1.15 to 16.9 per 100,000 children globally every year. Nephrotic syndrome relapses are associated with increased risk of progressive kidney disease, complications of nephrotic syndrome including infection and thrombosis, and adverse medication effects related to corticosteroid and immunosuppressive medication exposure. While upper respiratory infections are hypothesized to be a frequent cause of relapse, limited data exist regarding specific viruses that are more likely to be associated with nephrotic syndrome relapse.

Objective: This project's goal is to determine if specific respiratory viruses are more likely to be associated with relapse in pediatric nephrotic syndrome patients.

Design/Methods: We performed a retrospective chart review of approximately 206 pediatric patients with nephrotic syndrome treated at Rady Children’s Hospital San Deigo (RCHSD) between March 1st, 2016 and February 29th, 2020 using the RCHSD EPIC electronic health record and utilizing an existing dataset of nephrotic syndrome patients at RCHSD (IRB # 202040X). This data base includes all patients with a diagnosis of proteinuria, nephrotic syndrome, minimal change disease, focal segmental glomerulosclerosis, and membranous nephropathy. Data was deidentified upon collection. Dates and clinical circumstances of each relapse were collected from clinic notes, nurse telephone encounters, and hospital admission records. Community prevalence of each respiratory virus was collected using RCHSD viral respiratory swab reports. We will use RCHSD viral pathogen panel data to identify associations between relapses and viral outbreaks at the population level using a Poisson regression with a log link. Our outcome variable is the weekly number of relapses, and our explanatory variables are weekly counts of positive tests for adenovirus, rhinovirus/enterovirus, influenza A, influenza B, parainfluenza, and RSV. Total pathogen panels per month will be included as an offset term to account for testing volume. Model fit will be assessed using the residual deviance-to-degrees-of-freedom ratio; should overdispersion be detected, a Negative Binomial regression model will be applied. Exponentiated coefficients will be reported as incidence rate ratios, which will allow for the identification of which specific viruses are associated with higher relapse counts at the population level. All data analysis will be conducted using SPSS and R. The chart review has been completed, and respiratory pathogen panel data has been collected. Data analysis will be completed by January 10th, 2026.

Table 1
Table 1_Moss.pdfDemographic Information

Figure 1
Figure 1_Moss.pdfOverlay of nephrotic syndrome relapse data with viral pathogen panel data by week.