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 Table of Contents  
ORIGINAL ARTICLE
Year : 2022  |  Volume : 35  |  Issue : 3  |  Page : 1288-1293

Prevalence of Helicobacter pylori infection among children with nephrotic syndrome


Department of Pediatrics, Faculty of Medicine, Menoufia University, Menoufia, Egypt

Date of Submission28-Mar-2022
Date of Decision09-May-2022
Date of Acceptance12-May-2022
Date of Web Publication29-Oct-2022

Correspondence Address:
Mahmoud A. E.M. A. Eldaher
Elbaramon, Mansoura, Dakahlia
Egypt
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Source of Support: None, Conflict of Interest: None


DOI: 10.4103/mmj.mmj_105_22

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  Abstract 


Objective
To evaluate the prevalence of Helicobacter pylori infection among children diagnosed as having nephrotic syndrome (NS).
Background
NS is primarily a pediatric disorder and is 15 times more common in children than adults. H. pylori colonizes more than 50% of people worldwide.
Patients and methods
This prospective study was conducted on 50 children with NS admitted and followed up in the Pediatric Nephrology Unit at Menoufia University Hospital. They were screened for H. pylori by urea breath test, stool analysis (Rapid HpSA test), and serum H. pylori antibodies. The included patients were divided into two groups regarding clinical manifestations of H. pylori.
Results
The mean age was 8.80 ± 3.19 years, and 68% (34 cases) were males. Abdominal manifestations were more prevalent among patients with NS with H. pylori infection. The intake of NSAIDs increases the risk for H. pylori. There was a significant relation between H. pylori infection and platelet count and white blood cells among the studied patients. The diagnostic value of H. pylori stool antigen test was 100%, serum H. pylori antibodies was 90.9%, and urea breath test was 81.8%.
Conclusion
In the presence of unspecified abdominal pain and other gastrointestinal tract symptoms, H. pylori should be taken into consideration. Noninvasive diagnostic tests could be useful in diagnosis of H. pylori in children with NS.

Keywords: antral gastritis, Helicobacter pylori infection, hypoalbuminemia, nephrotic syndrome, urea


How to cite this article:
Hassan FM, Saleh NY, Eldaher MA, Elsalam HB. Prevalence of Helicobacter pylori infection among children with nephrotic syndrome. Menoufia Med J 2022;35:1288-93

How to cite this URL:
Hassan FM, Saleh NY, Eldaher MA, Elsalam HB. Prevalence of Helicobacter pylori infection among children with nephrotic syndrome. Menoufia Med J [serial online] 2022 [cited 2024 Mar 29];35:1288-93. Available from: http://www.mmj.eg.net/text.asp?2022/35/3/1288/359645




  Introduction Top


The incidence of nephrotic syndrome (NS) is 2–3/100 000 children per year, and most affected children have steroid-sensitive minimal change disease. The characteristic features of NS are heavy proteinuria (>3.5 g/24 h in adults or 40 mg/m2/h in children), hypoalbuminemia (<2.5 g/dl), edema, and hyperlipidemia[1] Most children achieve a complete remission when treated with oral prednisolone; however, even most responsive patients are likely to relapse, and some children have complicated patterns of response[2]. The fact that most of these patients respond to treatment with steroids, immunosuppressants, and immunomodulators has served as solid evidence to suggest the participation of the immunological system in its pathogenesis[3]. Helicobacter pylori colonizes more than 50% of people worldwide[4]. Infection with H. pylori is common in Egypt[5], where acquisition of infection occurs at a very young age[6] and is recognized to be associated closely with antral gastritis (gastric and duodenal ulcers in adults and children)[7]. There are two types of diagnostic tests used to detect H. pylori infection: noninvasive and invasive. Noninvasive tests include urea breath test, stool test, and blood tests. Invasive tests include the performance of upper gastrointestinal endoscopy with gastric biopsy[8].

The aim of this study was to evaluate the prevalence of H. pylori infection among children diagnosed as having NS.

In the presence of unspecified abdominal pain and other gastrointestinal tract (GIT) symptoms, H. pylori should be taken in consideration.


  Patients and methods Top


This prospective study was conducted on 50 children with NS who were followed up in the Nephrology Unit of the Pediatric Department of Menoufia University Hospital.

Ethical consideration: the Scientific Ethics Committee of Menoufia University approved the study protocol, and informed consent was taken from the parents before the children's enrollment in the study.

Patient characteristics: a total of 50 children with NS who were followed up in the Nephrology Unit of the Pediatric Department of Menoufia University Hospital were included.

Inclusion criteria were children with NS aged 1 month–18 years. After taking informed consent, all children were subjected to detailed history taking, complete systemic examination, and anthropometric measurements, including weight (kg), height (m), and BMI (BMI = weight (kg)/height (m2).

Routine investigations were performed as follows: complete blood count to detect hemoglobin; white blood cell (WBCs) and platelets were measured by an automated Sysmex XN-10 hematology Analyzer (Sysmex, Kobe, Japan); blood urea and serum creatinine were performed using an automatic biochemical analyzer (Erba chem7); and serum albumin and cholesterol were measured by an automated chemistry AU680 analyzer (Beckman Coulter Inc., Brea, California, USA).

Specific investigations performed were as follows: urea breath test, where the patient ingests radioactively labeled urea (either radioactive carbon-14 or nonradioactive carbon-13). If infection is present, the urease produced by H. pylori hydrolyzes the urea to form ammonia and labeled bicarbonate that is exhaled as CO2. The labeled CO2 is detected by either a scintillation counter (Carbon-14) and an isotope ratio mass spectrometry or mass correlation spectrometry (Carbon-13), stool analysis (Rapid HpSA test), and serum H. pylori antibodies.

Statistical analysis

Data were collected, tabulated, and statistically analyzed using an IBM personal computer with the Statistical Package for the Social Sciences (SPSS), version 20 (SPSS Inc., Chicago, Illinois, USA). The following statistics were applied: descriptive statistics, where quantitative data were presented in the form of mean, SD, and range, and qualitative data were presented in the form of numbers and percentages.

Analytical statistics were used to find out the possible association between studied factors and the targeted disease. The used tests of significance included the following: χ2 test was used to study the association between two qualitative variables; Fisher exact test was used to study the association between two qualitative variables when expected cell counts were less than 5; and Mann–Whitney test (nonparametric test) is a test of significance used for comparison between two groups not normally distributed having quantitative variables.

P value of more than 0.05 was considered statistically nonsignificant, P value of less than 0.05 was considered statistically significant, and P value of less than 0.001 was considered statistically highly significant.


  Results Top


The patients' mean age was 8.80 ± 3.19 years, ranging from 3 to 14 years. Overall, 68% (34 cases) were males. Mean disease duration was 6.23 ± 3.04 years, ranging from 1–12.5 years. Mean weight was 30.5 ± 7.94 years, ranging from 13 to 56 kg. Mean length was 125.7 ± 16.9 years, ranging from 90 to 156 cm. Mean BMI was 19.2 ± 3.26 ranging from 13.8 to 26.2. Regarding abdominal manifestations, 62% of patients complained of nausea, 40% had vomiting, 48% had abdominal pain, 6.00% had GIT bleeding, and 72% of patients had proteinuria [Table 1].
Table 1: Sociodemographic and clinical data of the studied group (n=50)

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H. pylori stool antigen test detect all positive cases and 71.8% of negative cases, whereas H. pylori antibody test detect 90.9% of positive cases and 69.2% of negative cases. Urea breath test detected 81.8% of positive cases (true positive cases) and 71.8% of negative cases (true negative cases) [Table 2].
Table 2: Diagnostic value of urea breath test and serology in diagnosis of Helicobacter pylori among the studied patients

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There was no significant relation between H. pylori infection and sociodemographic and clinical data (P > 0.05) [Table 3].
Table 3: Relation between Helicobacter pylori infection and sociodemographic and clinical data of the studied group (n=50)

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There was a statistically significant relation between H. pylori infection and abdominal symptoms among the children with nephritic syndrome [Figure 1].
Figure 1: Relation between Helicobacter pylori infection and abdominal symptoms among the studied patients.

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There was a statistically significant relation between H. pylori infection and intake of NSAIDs among the children with NS. No significant relation between H. pylori infection and steroid and immunosuppressive drugs. There was a significant relation between H. pylori infection and platelet count and WBCs among the studied patients (P < 0.05). There was no significant relation between H. pylori infection and hemoglobin level, serum urea, serum creatinine, and serum albumin levels among the studied patients (P > 0.05) [Table 4].
Table 4: Relation between Helicobacter pylori infection and drug history among the studied patients (n=50)

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  Discussion Top


The study included 50 patients with a mean age of 8.80 years. It is considered a higher mean age for incidence of NS in children. Epidemiologic studies of children with NS reported a mean age of 5.4 years[9]. NS in the current study was more frequent among males (68%). This comes in hand with Dossier et al.[9], which reported male-to-female ratio of 1.8. Same findings were reported in the demographic Egyptian study[10]. Contrary to our study, Esezobor et al.[11] reported a higher incidence of NS among female sex.

The diagnosis of H. pylori in our study was made based on clinical manifestations and positive H. pylori test among the studied groups. H. pylori stool antigen was positive in all H. pylori patients and in 11 out of 39 patients who were not diagnosed with H. pylori. Serum H. pylori antibodies test was positive in 10 of 11 patients with H. pylori and 12 of 39 patients who were not diagnosed with H. pylori, with a statistically significant difference. In the study by Nishizawa et al.[12], false-positive cases were reported in 33% of cases, similar to the percent of false-positive cases in our report (30%). Urea breath test was positive in 81.8% of the affected cases and 28.2% of the disease-free cases with a statistically significant difference (P0.001).

On comparing patients with H. pylori to disease-free patients, there was no statistically significant difference among both groups regarding age, sex, disease duration, and BMI. This comes in hand with other epidemiologic studies, which reported comparable incidence of H. pylori among both sexes and also between adults and children[13],[14]. Maged El-Sayed and Mohamed Abdel-Moneim[15] reported a higher incidence among female children with NS. In hand with our study, Xu et al.[16] did not find a correlation between BMI and incidence of H. pylori. On the contrary, there was an inverse correlation between increased BMI and H. pylori in the study by Lender et al.[17].

Maged El-Sayed and Mohamed Abdel-Moneim[15] reported an association of H. pylori and incidence of abdominal pain, vomiting, and nausea. The same findings were reported in our study. Abdominal pain was the main presenting symptom in children with H. pylori in the study by Nicolas et al.[18]. On the contrary, illustrated that gastrointestinal manifestations are not specific for H. pylori in children owing to increased incidence of viral GIT infections among such patients.

There was no association between use of steroids and incidence of H. pylori in the current study. Contrary to our study, Maged El-Sayed and Mohamed Abdel-Moneim[15] reported an association between steroid use and infection with H. pylori. The association was negative to steroid dose but positive to the disease duration. However, in our study, the disease duration was comparable among both groups. There was also no difference between steroid-sensitive and steroid-resistant patients in the incidence of H. pylori. Abed et al.[19] found a higher incidence among steroid-sensitive patients (94%), and they referred the results to the concomitant use of proton pump inhibitors in the disease-free group and also to the increased number of steroid-sensitive patients in their study. Moreover, Maged El-Sayed and Mohamed Abdel-Moneim[15] reported a higher incidence among steroid-sensitive patients. The majority of H. pylori group was maintained on NSAIDs owing to different reasons, with a statistically significant difference. This finding was confirmed in other studies[20],[21]. NSAID use is an independent risk factor for H. pylori in a study by Timshina et al.[22]. The combination is known to be associated with peptic ulcer incidence[23]. In the current study, there was no statistically significant difference between both groups regarding serum creatinine, urea, or serum albumin. In contrary to our study, Balat et al.[24] reported higher proteinuria levels among H. pylori -infected patients, but they performed their study on adult patients with diabetic nephropathy. Other studies reported improvement of proteinuria after eradication of H. pylori[25],[26]. Moreover, there is no conclusive evidence of association between H. pylori and renal impairment[27]. Both groups were comparable regarding hemoglobin level in spite of the presence of association between H. pylori and iron-deficiency anemia[28]. This may be referred to the use of iron supplements by the included children in our study. WBC count and platelet count were significantly higher among our patients with H. pylori. Elkhalifa et al.[29] reported the same findings regarding WBC but showed comparable platelet count. On the contrary, Stasi et al.[30] found improvement in platelet count in patients with ITP after eradication of H. pylori.


  Conclusion Top


In the presence of unspecified abdominal pain and other GIT symptoms, H. pylori should be taken in consideration. Noninvasive diagnostic tests could be useful in the diagnosis of H. pylori in children with NS.

Financial support and sponsorship

Nil.

Conflicts of interest

There are no conflicts of interest.



 
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    Tables

  [Table 1], [Table 2], [Table 3], [Table 4]



 

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