Evaluation of infections requiring hospital visits in immunocompromised patients with glomerular disease containing crescent and determination of related risk factors

Objectives: In this study, the patients who have been diagnosed with crescent-containing glomerulonephritis by kidney biopsy and being followed by Dokuz Eylul University Hospital Department of Nephrology, the detection of infections occurring after immunosuppressive therapy, the detection of infection focus and factors, laboratory findings, pathology findings, clinical responses of the patients to treatment, effects of treatment differences on infections and examining the effects of infections on the clinical course and comparing them with the current literature data, is aimed. Method: The study is carried out and designed as a retrospective research. The research group consists of 123 patients at the age of 18 and older, who have been diagnosed with crescentcontaining glomerulonephritis by kidney biopsy and whose biopsies are examined in our biopsy center; and also, after exclusion criteria 95 patients, who have no missing data, are included to this study. The demographic-clinical data of the study group, histopathological findings obtained from kidney biopsy, the treatments received by the patients, the infections that developed after the treatment and their severity and the laboratory data during the follow-up are registered. As evaluating the findings obtained from the study, SPSS (Statistical Package for Social Sciences) for Windows 24.0 package program was used for statistical analysis. Results: The pathological characteristics of the initial clinical, laboratory and renal biopsy of the 95 patients, who are included in the study, are evaluated in relation to the characteristics of the infections, kidney and general survival with their responses to treatment. In the study which is parallel with the literature data, it is observed that the level of Charlson comorbidity index over >2,5, creatinine level over < 2,84 mg/dl in diagnosis, eGFR level under < 23,5 ml/min/4 1,73 m2 according to CKD-EPI, and a dose of cyclophosphamide over >441,7 mg/m2 at a unit of time is important while determining infection-related mortality. It is detected that the age over >53,5, the level of Charlson comorbidity index over >2,5, the level of creatinine over >2,84 mg/dl in diagnosis, the level of eGFR under <23,5 ml/min/1,73 m² according to CKD-EPI, the level of 24 hours of urine proteinuria over >2,64 gr/day, the level of serum albumin under <3,04 gr/dl and a dose of cyclophosphamide over >441,7 mg/m² at a unit of time is important while determining infection-related mortality. The CKI level over >4 and the JVAS level over >5 through the infectious parameters, the presence of severe infection, the presence of lower respiratory tract infection and the presence of fungal infection were found to be significantly higher in patients with end-stage renal failure. Conclusion: In patients with crescent-containing glomerulonephritis, the disease itself and side effects that developed after the immunosuppressive treatments, especially infections, are the main factors affecting the patient and kidney survival. In this study, it is revealed that accompanying Charlson comorbidity index, Japanese Vasculitis Activity Score, albumin, eGFH, haemoglobin, creatinine, proteinuria level, presence of steroid-induced diabetes are associated with the presence of severe infection. Presence of dialysis need, steroid-induced diabetes, end stage renal disease, severe infection, lower respiratory tract infection, fungal infection, steroid therapy dose and cyclophosphamide dose per unit body surface area, might be valuable in predicting the course of the disease according to the various clinical endpoints. Long-term side effects and safety studies should be conducted in larger groups of patients to reveal the side effects of immunosuppressive treatments.